Safer road users

Key messages

• Countries in the Region are strengthening their legislation on six behaviors that are central to road safety. However, most of these regulations need to be adjusted to good legislative practice standards.
• Thirty-one countries have introduced legislation on maximum speed limits. However, only nine have laws based on good practice.
• All countries have a regulatory framework for drink driving; however, only eight meet the standards for appropriate legislation.
• Driving under the influence of other psychoactive substances is legally restricted in 31 countries. However, mitigation of this risk has not progressed at the same rate as that of drink driving.
• Twenty-seven countries have national legislation prohibiting mobile phone use while driving. Most laws regulate the use of handheld mobile phones, and, to a lesser extent, the use of hands-free devices.
• Thirty countries have laws on helmet use, but these laws apply to all users, roads, and vehicles in only seven. Ideally, helmets should be fastened and meet quality standards.
• Seat belt use is regulated in 31 countries in the Region; however, only 21 countries require that all vehicle occupants wear them.
• Twenty-one countries regulate the use of child restraint systems (CRS). Only five of these meet the recommended standards (use up to 10 years of age or 135 cm tall, compliance with a CRS standard, and prohibiting children from traveling in front seats).
• Countries in the Region must gather more comprehensive information on road behavior, primarily through regular, national observational studies. Speeding, the use of CRS, and seat belt use among rear-seat occupants are the behaviors on which the fewest countries record data.
• More effective law enforcement is needed. In most cases, experts believe laws are poorly enforced, mainly regarding the use of CRS.

Individual behaviors are a significant source of risk for the road system. Speeding, drink driving, and mobile phone use while driving are some of the behaviors with the most impact on road traffic safety. These behaviors significantly increase the likelihood of a road traffic crashes, and the severity of its consequences. Some behaviors also help mitigate the impact of these crashes. These include the use of motorcycle helmets, seat belts, and child restraint systems (CRS). Avoiding risky behaviors and encouraging the use of protection systems is essential to improving road traffic safety.

An important strategy to make road users safer is the implementation of regulatory frameworks designed to regulate such behaviors. WHO has good legislative practice standards for most risk and protection behaviors. These standards provide the necessary framework for formulating appropriate laws. When effectively enforced, these laws improve road traffic safety.

This section presents the current regulations of countries in the Region on three risk behaviors (speeding, drink driving, and mobile phone use while driving) and three protection behaviors (use of motorcycle helmets, seat belts, and CRS). The data provided aim to answer three main questions: To what extent do the laws comply with WHO’s good legislative practice criteria? How effectively do experts believe laws are being enforced? and How far are countries in the Region from reaching the road behavior targets of the Global Plan 2021-2030? Finally, some results-based recommendations are made.

Analysis of legislation on behavioral factors

Speeding

Road user safety can be seriously compromised by motor vehicle speed. This includes exceeding legally established speed limits and driving at inappropriate speeds on certain roads (15). This behavior poses a significant challenge for road safety policies. It is often commonplace and tends to receive less social disapproval than other behaviors (e.g., drink driving) (16). Achieving safer speeds therefore requires the comprehensive implementation of educational, environmental, vehicle, and regulatory strategies.

Target 6 of the Global Plan 2021-2030 aims to halve the proportion of vehicles exceeding speed limits, as well as reduce speed-related injuries and deaths. A key indicator for assessing compliance with this target is the number of countries that have effectively implemented legislation based on good practice. According to WHO recommendations, appropriate laws should establish a maximum speed limit of 50 km/h in urban areas, and grant local governments the autonomy to define specific limits suitable for certain roads (3). The following describes how countries in the Region have progressed in terms of compliance with these recommendations.

Table 9 shows that all countries have legislation on maximum speed limits, except for Dominica. Around half enforce speed limits of 50 km/h or less in urban areas.²⁶ However, only 14 countries allow local authorities to modify speed limits.²⁷ Consequently, only nine countries have laws based on good practice (Figure 28).

Table 9. Country responses to legislative good practice indicators on speed

Figure 28. Compliance with recommended legislative good practice on driving speed

Experts were asked to rate how effectively speed limit laws were being enforced. On a scale of 0 to 10, their average rating was 5.39. Enforcement was considered to be highly effective (a rating of 7 or more) in only eight countries.²⁸ In most countries (15), it was considered moderately effective.²⁹ In five countries, enforcement was deemed to be ineffective.³⁰ Four countries provided no information in this regard.³¹

In addition to legislative aspects, countries were also asked about the prevalence of speeding. Only a quarter had this information.³² The figures provided showed significant variability —ranging from 3% to 88%— and in two cases, the data predated 2020.

Improving speed-related regulatory frameworks is important to achieve Target 6. Most countries lack legislation that meets good practice standards. Furthermore, few countries reported highly effective law enforcement, suggesting the need to strengthen enforcement actions. Both aspects are essential to achieving safer speeds.

In any case, the situation in the Region has improved somewhat. In the 2019 PAHO report (9), five countries complied with good legislative practice. This number has now increased to nine. There has also been an increase in the number of countries whose law enforcement is regarded as highly effective. In 2019, no countries received an enforcement rating above 8, whereas five countries in this report obtained that rating.

Monitoring and data collection strategies must be optimized. Only eight out of 32 countries provided estimated speeding percentages. Moreover, the information is not always up to date and has validity issues. It is therefore recommended that road user speed be regularly recorded, especially through national observational studies (Box 11).

Driving under the influence of alcohol and other psychoactive substances

The negative consequences of drink driving are widely recognized. Alcohol impairs perceptual-motor skills essential to safe driving, leading to slower reaction times, reduced peripheral vision and visual acuity, and difficulty accurately estimating speed (17). Alcohol also increases self-confidence while driving. The combination of both effects (i.e., reduced skills and overconfidence in driving ability) exposes individuals to a higher risk of road traffic crashes (17).

Due to the significance of this behavior, Target 9 of the Global Plan 2021-2030 is to reduce the number of road traffic injuries and deaths resulting from drink driving and driving under the influence of other psychoactive substances. One indicator to assess the progress of this target is the number of countries with appropriate legislation. According to WHO, appropriate drink driving legislation fulfils four criteria: i) the existence of national regulations governing drink driving, ii) alcohol levels defined using blood alcohol content (BAC), iii) an established alcohol limit for drivers in the general population of ≤ 0.05 g/dL, and iv) an alcohol limit for novice drivers of ≤ 0.02 g/dL (3). Below are the results on how countries in the Region meet these criteria.

All 32 countries have a national law on drink driving (Table 10). Only three countries do not define alcohol levels using BAC.³³ Seventeen countries have laws governing the alcohol limit for general population drivers (0.05 g/dL),³⁴ while seven³⁵ and nine³⁶ countries, respectively, have recommended limits for novice and professional drivers (≤ 0.02 g/dL). In summary, eight countries’ legislation complies with WHO-recommended good practice (Figure 29).

Table 10. Country responses to legislative good practice indicators on drink driving

Figure 29. Compliance with recommended legislative good practice on drink driving

Effectiveness of law enforcement was rated 5.25 on average, on a scale of 0 to 10. Only 10 countries reported highly effective enforcement.³⁷ Another 10 reported moderately effective enforcement.³⁸ Seven countries said that law enforcement was ineffective: the Bahamas, Barbados, Dominica, the Dominican Republic, Honduras, Jamaica, and Saint Lucia. Only five countries did not provide this information.³⁹

One strategy to deter people from drink driving and strengthen law enforcement is implementing random breathalyzer checks. Fifteen of the 32 countries reported carrying out checks.⁴⁰ However, when it comes to road traffic crashes with fatalities, only 12 countries assess the blood alcohol level of all drivers.⁴¹ Sixteen countries provided the percentage of road traffic crashes with deaths attributable to drink driving (between 2% and 30%),⁴² three of which provided data that predated 2020 (Argentina, Brazil, and Canada).

In addition to drink driving, questions were asked on legislation and monitoring strategies for driving under the influence of other psychoactive substances (Table 11). All countries, except Haiti, have national legislation on this matter. Fifteen countries conduct tests to detect the use of other psychoactive substances in the event of crashes: four countries conduct these tests in crashes resulting in fatalities or injuries, two countries only conduct them if the driver dies, and nine countries conduct them on some drivers (in both fatal and non-fatal road traffic crashes).

Table 11. Country responses to questions on legislation and monitoring of driving under the influence of other psychoactive substances

The results indicate that regulatory frameworks must be aligned with WHO-recommended standards to achieve Target 9 of the Global Plan 2021-2030. Alcohol limits for novice drivers are the least widespread criteria constituting good practice, followed by alcohol limits for professional drivers. According to experts, most countries do not have effective enough mechanisms to enforce their laws.

Eight countries comply with legislative good practice, the same number as the PAHO report published in 2019 (9). However, the number of countries whose law enforcement is regarded as highly effective has increased from three to 10.

More countries also provided data on road traffic crashes related to drink driving, rising from 13 in 2019 to 16 in this report. It is important to note, however, that monitoring of this behavior has decreased. In 2019, 21 countries carried out random breathalyzer tests on all drivers, while 16 countries conducted these tests in road traffic crashes resulting in fatalities. The most recent data show a decline in both indicators (down to 15 and 12 countries, respectively).

There were some differences regarding the use of other psychoactive substances while driving, compared to the previous report. In 2019 (9), PAHO said that all countries had legislation on this matter. This was almost the case in this report; however, one country that did not participate in the previous report (Haiti) reported having no regulatory framework. In terms of data collection, only five countries in the previous report carried out drug screening tests on deceased drivers. Now, 15 countries carry out these tests, although four do so for fatalities and injuries, two when there are fatalities only, and nine on certain drivers only. In summary, these results highlight the need to strengthen monitoring and data recording systems, which is key for identifying the scope and needs related to Target 9.

Distracted driving: mobile phone use

Any activity secondary to driving (such as talking on a mobile phone, eating, or adjusting the radio) can lead to distractions that impact safe driver performance. The common denominator in distracted driving is that the driver stops paying attention to information essential to driving safely (18, 19). Distractions reduce the ability to assess and respond to changing traffic conditions, increasing the risk of crashes (3). Mobile phone use is one of the most concerning distractions as regards road safety. This behavior is consequently included in the targets of the Global Plan 2021-2030. Target 10 is that, by 2030, all countries have national laws to restrict or prohibit the use of mobile phones while driving that are effectively enforced. The Region’s results regarding legislation of this behavior are described below.

Table 12 shows the response percentages to questions related to legislation on distractions and mobile phone use while driving. Most countries have a national law on distracted driving, particularly mobile phone use. Antigua and Barbuda, Belize, Bolivia (Plurinational State of), and Dominica have no legislation on distracted driving. These countries also have no regulatory framework restricting mobile phone use while driving. The Bahamas provided no information.

Table 12. Country responses to questions related to legislation on distractions and mobile phone use while driving

Unlike other road behaviors, there are no legislative good practice standards for distractions and mobile phone use while driving. However, countries can be divided into four groups based on their responses to questions on this behavior. The first group, consisting of eight countries, answered yes to all questions.⁴³ These countries have laws on distractions and mobile phone use, including handheld and hands-free devices. The second group, consisting of 19 countries, has laws on distractions and mobile phone use, but does not prohibit the use of hands-free devices.⁴⁴ The third group includes four countries that have no legislation on distractions or mobile phone use.⁴⁵ Finally, Saint Lucia has legislation on distractions and mobile phone use, but does not specify the type of use prohibited (i.e., handheld or hands-free).

Distractions and mobile phone use while driving are regulated in much of the Region. New legislation is required in four countries only, to achieve Target 10. However, two issues must be highlighted. Target 10 mentions effective law enforcement, but there is no information on this. The lack of good practice standards also makes it difficult to establish the significance of country-specific differences, particularly regarding how mobile phones are used (handheld or hands-free).

Progress has been made in legislating this behavior since the 2019 PAHO report (9). In the previous report, 21 countries prohibited mobile phone use while driving and seven prohibited the use of hands-free devices. The number of countries regulating both methods has now risen to 27 and eight, respectively.

Countries must conduct further targeted studies and create data registries on distracted driving, especially mobile phone use.

Failure to use helmets among motorcyclists

Motorcyclists are among the most vulnerable road users in the Region. Helmet use is the main passive safety measure for this population (3). The Global Plan 2021-2030 aims to achieve near-universal helmet use. Helmet use should extend to all individuals (drivers and passengers), and helmets are expected to meet a quality standard. Additional safety measures should be implemented for children, such as specific age- and weight-appropriate restraint systems.

The previous PAHO report indicated that few countries adhered to legislative good practice regarding helmet use, in particular, the correct and mandatory use of a certified helmet for all occupants, roads, and motorcycle types. It also mentioned that the perceived effectiveness of law enforcement was low, and that helmet use was far from universal, according to country-reported information.

Only seven countries have laws covering all users, motorcycle types, and roads, requiring that helmets be properly fitted and meet a safety standard certification (Table 13). Two countries still have no legislation on helmet use (Antigua and Barbuda, and Dominica). The law in four countries does not apply to all occupants, vehicles, or roads.⁴⁶ Nineteen countries have laws specifying that helmets must meet safety standard certification.⁴⁷

Nineteen out of 32 countries provided data on the percentage of motorcyclists (specifically, drivers) wearing helmets:⁴⁸ five reported a percentage below 60%, three reported a percentage between 60% and 89%, and only 10 countries reported a percentage of 90% and above. Fourteen out of 32 countries provided data on the percentage of passengers wearing helmets:⁴⁹ six reported a percentage below 60%, two reported a percentage between 60% and 89%, and six reported a percentage of 90% and above.

Experts were asked to rate how effectively helmet use was being enforced. On a scale of 1 to 10, the average rating was 5.67. Only four out of 29 countries scored a rating of 8/10 or higher.⁵⁰

Finally, only seven countries in the Region establish minimum age or height limits for child motorcycle passengers.⁵¹

Table 13. Country responses to questions on helmet legislation

Helmet use remains a challenge for many countries in the Region. According to the estimates provided, few are close to reaching Target 7: “By 2030, increase the proportion of motorcycle riders correctly using standard helmets to close to 100%.” Furthermore, only half of the countries provided estimates on helmet use, making it difficult to assess the regional situation. It is therefore essential to improve nationally representative observational studies.

No major regulatory progress has been made since the previous regional report (9). Only seven countries have current laws that comply with good legislative practice in this area (Figure 30). Regulatory progress is needed, especially to establish a quality standard for helmets.

Regulatory enforcement was also perceived to be ineffective; only four countries rated it 8/10 or higher. Actions are needed to help ensure all occupants comply with the regulations. Creating legislation to regulate minimum ages and safety conditions for children traveling on motorcycles must also be on the agenda.

Figure 30. Compliance with recommended legislative good practice on helmet use

Failure to use seat belts

Seat belt use is the main passive safety measure for occupants of vehicles with four or more wheels (3). As with helmets, Target 8 of the Global Plan 2021-2030 is to achieve near-universal use. Achieving this target requires appropriate regulations, enforcement, education, and public communication strategies. Standards should apply to all occupants in all parts of a vehicle, including the use of CRS for children. The 2019 PAHO report (9) said that only half of the countries met the criteria for legislative good practice on seat belt use. In addition, only five countries rated their enforcement as 8/10.

The two good practice criteria below were used to review legislation on seat belt use: i) existence of a national law on seat belt use, and ii) application of this law to all vehicle occupants (not just drivers). The perceived effectiveness of enforcement and country-reported prevalence of seat belt use was also analyzed. All countries except one (Antigua and Barbuda) have national legislation on seat belt use. In 21 countries, the law applies to all vehicle occupants. In the others, it only applies to drivers or front-seat occupants (Figure 31).

Eighteen countries reported estimated seat belt use among drivers;⁵² four countries reported use below 60%, nine between 60% and 89%, and five of 90% or more. Fewer countries (15) reported estimated seat belt use among front-seat occupants;⁵³ five countries reported use below 60%, six between 60% and 89%, and four of 90% or more. Only nine countries reported estimated seat belt use among rear-seat occupants;⁵⁴ eight countries reported use below 50%. On average, effectiveness of law enforcement was rated 6/10. Only five countries had a rating of 8 or more.⁵⁵

Figure 31. Compliance with recommended legislative good practice on seat belt use

Based on country-reported estimates, few are close to achieving Target 8 of the Global Plan 2021-2030, which aims to achieve near-universal seat belt use by all occupants. The data collected indicate that the biggest challenge will be increasing usage percentage among rear-seat passengers. It is also worth noting that only half of the countries provided estimates on seat belt use. As for helmets, national observational studies must be conducted to monitor this behavior and track progress towards the proposed target.

Twenty-two countries have laws that meet the legislative good practice criteria analyzed. Regulatory progress is needed in the rest, especially with regard to mandatory seat belt use for all occupants (and not just those traveling in the front seats). Mechanisms for enforcing regulations on seat belt use must also be improved. Only five countries rated the effectiveness of enforcement as 8/10 or higher. Naturally, these actions must be accompanied by awareness and road education strategies.

Failure to use Child Restraint Systems

Use of CRS is another key behavioral indicator for assessing and monitoring the status of road safety, specifically among children (3). However, it is one of areas most neglected by regulations and enforcement actions.

The 2019 PAHO report (9) said that only two countries met all four CRS good practice criteria, namely: i) having a national law on CRS use; ii) mandatory CRS for children under 10 years of age (or 135 cm tall); iii) restrictions on children of a certain age or height sitting in the front seat, and iv) referral to norms, certifications, or standards on CRS. Only one country (Canada) in the report rated compliance with CRS use as “satisfactory” (8/10 points). Only 10 countries reported collecting data or conducting specific studies on the use of this safety system.

Table 14 shows that 11 countries in the Region still have no laws on CRS, and 18 have no laws specifying use by age or height. Only five have laws stipulating that children under 10 years old or 135 cm tall must use a CRS that meets a given standard and must not travel in the front of the vehicle, thus complying with all good practice recommendations.

Experts rated the enforcement of CRS use as very low (average score of 3.38 on a scale of 1 to 10). Only three countries rated law enforcement as 8 or higher.⁵⁶ Finally, only 12 countries collected data on CRS use.⁵⁷

Table 14. Country responses to questions on legislation related to the use of child restraint systems

No significant progress has been made in this area since the 2019 report (9). Almost a third of the countries in the Region still have no CRS legislation, and very few have laws that comply with recommended good practice in this area (Figure 32). It is important to enact regulations requiring children under 10 years old or 135 cm tall to use a CRS that meets a given standard, and forbidding them to travel in the front seat. The perceived effectiveness of law enforcement on CRS use also remains very low. Improved strategies to manage and promote the use of these systems are needed. Systematic studies providing reliable data on national CRS use must also be conducted. Few countries still have this information.

Figure 32. Compliance with recommended legislative good practice on child restraint systems

Conclusions

1. Current legislation must be adapted to good practice standards and regulatory enforcement mechanisms must be improved. Improving data recording and monitoring systems for road traffic behavior is essential to achieving the targets of the Global Plan 2021-2030.
2. Despite an increase in legislation on mobile phone use since 2019, more data and specific studies on distracted driving are needed.
3. Conducting nationally representative observational studies is crucial. So too is enacting regulatory changes to make quality standards for helmets mandatory, and establish minimum ages and special safety conditions for children.