Road Safety in the Dominican Republic a Public Health Problem.

The issue of Road Safety in the Dominican Republic has become a priority as a public policy, according to the Pan American Health Organization (PAHO), in a report carried out in 2018, on Road Safety in the Americas, showed that the Dominican Republic is the second country with the highest mortality rate from traffic accidents in the region (34.6 deaths per 100,000 inhabitants) and the 5th worldwide; which represents a high mortality in vulnerable road users led by motorcyclists (67%), pedestrians (17%) and cyclists (1%), which together account for 85% of that mortality; contrary to how it happens in other countries where that mortality represents 45% %. The Global Plan for the Decade of Action for Road Safety 2021–2030, endorsed in UN resolution 74/299, aims to reduce road deaths and injuries by 50% by the end of the decade.   

Dr. Amado Alejandro Báez, professor, distinguished graduate and researcher of Universidad Nacional Pedro Henríquez Ureña (UNPHU), with Dr. Ramón Leonel Ureña, specialist in Family Medicine, expressed that in the context of Road Safety should not only be focused as an independent problem, but as a multifactorial and multisectoral integrated component of many agendas, hence the participation of multiple political, economic, social and environmental actors for its implementation; which obliges a commitment of the government, private sector, media, academies or universities, international organizations, non-governmental organizations, driver unions, public transport company, private and freight, unions of the health sector and other stakeholders in the prioritization and implementation of public policies that on Road Safety as a key driver of sustainable development.

They also indicated that the multiplicity of actors each with resources and capabilities and very particular interests forces the consensus when it comes to developing strategies to achieve impact the havoc that road accidents produce in the Dominican Republic, with high mortality and injuries in young people, traffic congestion on public roads, excessive expenses in the assistance provided by the health system ( from 3 to 5% of GDP), poor management of implementation of agencies responsible for Road Safety, transit and mobility, and environmental damage resulting from the emission of greenhouse gases; The truth is that the issue of road safety and public 

policies implemented by the government do not escape situations of conflict and ungovernability between the different actors interacting in the problem. 

The government through INTRANT and as part of its policy of citizen and road safety has ordered the regularization and registration of motorcycles, which has been rejected by motorcycle associations for the irregular collection of taxes.

All this action of the government and interested parties seeks to promote and agree on public policies aimed at better mobility and road safety that can reduce the high level of road accidents in an environment of concertation and peace, to ensure governance in this aspect of the institutional life of the Dominican Republic. 

On the issue of road safety, the government and society in general have many challenges to face; there are multiple situations that generate conflicts in traffic, mobility, and security of citizens. Among the most notable and constant sources of disgust and clashes between the actors that influence the problem are:

• Increase of the vehicle fleet without control or criteria with 300 thousand units each year (6% per year) that aggravates the congestion of public roads, increasingly limited and narrow, causing strong clogging, delays, and much irritation among passers-by frequent causes of protests and physical and verbal violence.
• Poor public transport, based on light cars that make it difficult and limit the transport of the population to work centers or studies.
• Lack of enforcement of traffic rules, leading to friction between authorities and citizens.
• Vulnerable road users (motorcyclists, pedestrians, and cyclists) totally unprotected, presenting high mortality or injuries rates.
• Poor quality of responses to medical assistance in the event of accidents on roads and highways.
• Poor management of road safety agencies at national and local levels, including issues such as the environment and gender.

Given the complexity of the problem and resource constraints, a commitment is imposed as a nation where all sectors contribute to its solution, establishing the relevant priorities. 

Topics such as the crowding and collectivization of transport in investments to develop bus routes, trams, subways, cable cars are proposed as a solution. Development of public policies for the protection of the most vulnerable road users (Motorcycle Plan, Pedestrian Plan, among others). Regulations for increasingly safe vehicles and roads; as well as increasingly trained and equipped traffic police (DIGESSETT), road education plans and a rapid response to the occurrence of road accidents are also required on the roads that are within the short-, medium- and long-term measures. 

Trauma Care Systems and Public Health

According to recent statistics from the World Health Organization, the Dominican Republic occupies the first position in the world in the mortality rate due to traffic accidents with 64.6 deaths per year per hundred thousand inhabitants.

The Dominican Republic in recent years has seen great advances in emergency care, but trauma remains the leading cause of morbidity and mortality in productive age, resulting in the highest socioeconomic impact. Studies show that this socio-economic impact of trauma is even greater in middle-income countries, so the opportunity and benefits of a real organization are greater in countries such as the Dominican Republic. It has been shown that investment in the organization of trauma systems and habilitation of regional trauma centers articulated with the prehospital system (and community elements) has an important return on investment with a higher cost-utility, given the direct impact on quality-adjusted life years.

With the leadership of Universidad Nacional Pedro Henríquez Ureña (UNPHU), Trauma RD project was launched in 2019, developing a “Social Think Tank” platform integrating national and international public and private actors, to work in a collaborative way on a comprehensive agenda that helps formulate solutions to address the very important public health problem that trauma represents in the Dominican Republic.

The professionals that make up Trauma RD group highlight the urgency of establishing a national trauma system; more than 3 thousand people have signed the Declaration of Punta Cana (DPC): Commitment Creation of a Dominican Trauma System hanging on the virtual platform Change.org where a detailed description of the project is made where the RD Trauma agenda proposes the creation of a National Trauma Committee (CNT). This would be ideally with public-private collaborations with the aim of developing and executing an agenda that allows defining priorities and working on the development of a Comprehensive Trauma System. 

Trauma is one of the main challenges of Dominican public health, affecting everyone without social, racial, religious, or economic discernment. In the end, the trauma has touched us all and in this way we all, as a collective, must act and contribute to reduce its social, health and economic burden in our nation.