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Even when injury prevention is not the primary focus of a new policy, it is important to consider the implications for injury risk
In the opening paper for the Policy Forum section of Injury Prevention,1 Jon Vernick presented a definition of an injury‐related policy as “a rule or decision having the capacity to guide or determine the actions of individuals […] with the goal of affecting the surveillance, risk, incidence, severity, disability, cost, or other aspects of injury.” However, policies that do not necessarily have the goal of affecting injury can nevertheless have a profound influence on the risk and burden of injury. A powerful example is the recent changes to motorcycle licensing policy in Spain. We argue that even when injury prevention is not the primary focus of a new policy, it is important for policy‐makers to consider the implications for injury risk and to obtain expert guidance.
As Spain is a warm‐climate country of some 40 million people, mopeds and motorcycles are a common means of transportation. In 2003, 10% of Spain's licensed drivers held a moped or motorcycle‐only driving license, and an additional 2% held dual licenses that allowed them to operate both passenger cars and motorcycles.2 However, moped and motorcycle riders bear a disproportionate share of the burden of road traffic death in Spain, accounting for 20% of fatally injured motor vehicle occupants in 2003.2 This high exposure to two‐wheel vehicles is in part responsible for Spain's relatively high motor‐vehicle‐related death rate; Spain ranks 15th among 25 European countries in its motor‐vehicle‐related fatalities per million inhabitants.3
Despite these sobering statistics, beginning in 2004, the Spanish government actually made it easier to operate a motorcycle (table 11).). Before 2004, operators of motorcycles regardless of engine size had to meet minimum age requirements, complete a safety course, and pay associated fees of approximately €120–400. People with a license to drive a passenger car, but not a motorcycle, still had to complete additional training and pay the fee.
The official statement of Real Decree 1598 released by the Spanish government in 2004 stated that “with the goal of improving traffic flow and thereby reducing the number of circulating automobiles with only one person on board, […] drivers [meeting certain other criteria] will be allowed to drive motorcycles not larger than 125 cc with no further licensing requirements.”4 This means that people who have held a license to operate a passenger car for at least 3 years can now drive a motorcycle of no more than 125 cc (including the popular Vespas) without any additional licensing requirements.
One immediate consequence of the policy change has been a large increase in the number of smaller motorcycles in Spain. Compared with the approximately 15000 motorcycles between 50 cc and 125 cc registered yearly before the regulatory change, in 2004 there was an increase in registrations of 129%, followed by another increase of 172% in 2005, with total sales that year of 105194 units.2 It is estimated that Spain now has more than 4 million mopeds and motorcycles on its roads, ranking 3rd after Germany and Italy. Regardless of their effectiveness as an injury prevention intervention, the prior educational programs and fees apparently acted as a de facto “barrier” to obtaining a motorcycle operators' license for some.
Not surprisingly, since 2004, the number of fatal motorcycle‐related crashes in Spain has also increased. Between 2003 and 2005, there was a 28% increase in motorcycle deaths, despite the greater use of helmets.5,6 This increase is even more distressing when compared with an 18% reduction in deaths in all other motorized means of transportation.2
However, there is no national travel survey in Spain to provide detailed information about how many kilometers are driven nation‐wide by different means. Therefore, we do not know if the increase in motorcycle registrations reflects a substitution of motorcycles for passenger cars or a net increase in motorized travel—that is, a substitution of motorcycles for walking.
The relaxation in legislation allowing up to 15 million additional Spaniards who held passenger car driving licenses to now drive motorcycles below 125 cc did not adequately consider the known risk of increased motorcycle use. In fact, motorcycle users have a 58‐fold increased risk of being killed compared with passenger car occupants on a per 100 million trip basis,7 a risk so large that there are few other public health risks of this magnitude. It also ignored evidence linking increases in motorcycle sales with substantial increases in deaths in the USA.8
Paradoxically, injury prevention has gained increased prominence in some other Spanish health‐related policy forums. For example, in 2001 Spain adopted the EU goal of a 50% reduction in fatalities due to motor vehicle crashes for 2010, and a number of other “injury‐prevention” policies have been recently discussed and implemented.9 Yet, a major regulation, carrying a high risk of enhancing exposure to injury, such as allowing more people to drive motorcycles, was enacted with little input from the injury‐prevention community. As the EU embarks on a new discussion of motorcycle licensing policies, while also holding a parallel discussion of transportation policies, it is critically important that policy‐makers receive input from injury‐prevention experts. If mopeds and motorcycles are to be encouraged as part of this process, careful assessment of how to decrease their associated risks is needed.
Obviously, relieving traffic congestion is a popular concern and has become a hot‐button issue in the climate change debate.10,11 However, transportation decision‐makers must also consider the net effects of their decisions on injury.
The lives of almost 100 people may have been lost in Spain in 2005 because of this change in motorcycle licensing regulation. To prevent similar setbacks in the future, the injury‐prevention community must recognize that even policies that do not appear to be directly related to injury risk can have unintended consequences.
We thank Montserrat Ruiz for her assistance in both the compilation of data and the editing of the manuscript.
Competing interests: None.