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Story Publication logo August 12, 2013

Not God's Will: The Fixable Crisis of Traffic Fatalities

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Roads Kill

From HIV/AIDS to malaria and tuberculosis, poor countries endure more than their share of health...

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Heavy traffic on a highway into central Jakarta. This scene is typical in many of Asia's rapidly developing urban centers. Image by Kristianto Purnomo. Indonesia 2013.

The global death toll has already reached 1.24 million per year and is on course to triple to 3.6 million per year by 2030.

In the developing world, where this pandemic has hit hardest, it will become the fifth leading cause of death, leapfrogging past HIV/AIDS, malaria, tuberculosis and other familiar killers, according to the most recent Global Burden of Disease study.

The victims tend to be poor and overwhelmingly young and male.

In one country—Indonesia—the toll is now nearly 120 dead per day; in Nigeria it is claiming 140 lives each day.

If you haven't guessed already, this global killer is our most necessary accessory, the essential thing that gets us from here to there: the motorized vehicle.

"Developing countries have 50 percent of the world's road traffic but 90 percent of the traffic fatalities," said Stein Lundebye, a road safety pioneer and former leader of the World Bank's road safety task force. "It's a big public health problem, a big socio-economic problem."

It's also a "poverty-inducing problem," according to Jose Luis Irigoyen, director for Transport, Water, and Information and Communication Technologies for the World Bank. "It's costing on average between 1 and 3 percent of GDP" in low- and middle-income countries, he says, an amount that can offset the billions of dollars in aid money that these countries currently receive.

In 2010, the United Nations General Assembly unanimously adopted a resolution calling for a "Decade of Action" on road safety. The goal is to stabilize and eventually reverse the upward trend in road fatalities—saving an estimated 5 million lives during the period. The World Bank and other regional development banks have made road safety a priority, but according to Irigoyen, donor funding lags "very far below" the $24 billion that has been pledged to the Global Fund to fight AIDS, tuberculosis and malaria.

"Roads Kill" is a Pulitzer Center initiative that draws on its extensive global network of journalists to raise the visibility of this growing public health crisis. The entire project, including an interactive map and an ever-expanding roster of reports from around the world, is fully embeddable. We welcome others, including news organizations, to make use of these resources—and to contribute stories of their own.

The encouraging news is that this epidemic of road deaths is curable and preventable. In fact, the toll has already been effectively eradicated in some wealthy countries. Sweden, for example, had only 266 road fatalities in 2010, a rate of 2.9 deaths per 100,000 citizens. In Thailand and the Dominican Republic, the comparable rates are 41 per 100,000.

In the developing world, particularly in Africa and parts of Asia where the body count is skyrocketing, there is a tendency to ignore the problem, shrug it off as the inevitable cost of economic progress or simply accept as God's will that accidents must happen.

"The biggest problem is that when somebody gets killed on the highway, we still call it an 'accident.''' said Mustapha Benmaamar, the World Bank's senior transport expert in Jakarta. "Only when it is not perceived as an accident, as something that is bound to happen, can we begin to solve this."

Most of Western Europe and North America have experienced a steep and steady decline in the number of highway fatalities since the mid-1970s when political leaders and lawmakers got serious about enforcing seat belt laws, cracking down on drunk driving and compelling auto manufacturers to build safer vehicles.

In addition to these measures, highway safety experts can point to several other steps that can be taken to reduce road fatalities.

  • Mandatory driver's education: In a surprising number of countries, not knowing how to drive is no hindrance to obtaining a driver's license or getting behind the wheel. In Nigeria, for instance, the Federal Road Safety Commission only recently made it compulsory for new drivers to take driving lessons and pass a test before obtaining a license; in the past it was possible to buy a license for a few dollars.
  • Better policing: In much of the developing world, road safety is often relegated to traffic wardens who often seem preoccupied with soliciting petty bribes. Also, it's hard to catch speeders and other motorized violators when you are on foot.
  • Engineer safer roads and highways: This includes everything from upgrading crash barriers and signage to making sure that traffic signals actually work. The problem is that in many developing countries there are no barriers to upgrade or signals to make work. And signals may actually increase the number of crashes. "Engineering safer roads involves developing and implementing traffic control standards that consider the needs of the most vulnerable—the pedestrian and the bicyclist," says Juan Morales, a Virginia-based transportation engineering consultant.
  • Slow down: Speed really does kill. But in many of Asia's booming economies, progress is measured in cubic meters of concrete poured and miles of new roadways built. This speeds up the business of getting from here to there, but it also increases the risk of getting killed or maimed along the way, especially in congested urban areas. Only 59 countries, covering just 39 percent of the world's population, have implemented urban speed limits of 50 km/h or less, according to a ground-breaking study by the World Health Organization (WHO).
  • Call an ambulance: Easier said than done in most of the world. Accidents will happen, and fast professional medical care can save lives, but too often seriously injured accident victims either bleed by the side of the road or are bundled into the backseat of a taxi for a bumpy ride to the hospital.

As anyone who has visited Cairo or Manila or Nairobi knows, driving in the developing world—or even attempting to cross the street—can be a harrowing experience. Our Pulitzer Center colleague Matthieu Aikens recently wrote an e-book about the trucks that supply the war in Afghanistan—and the men who drive them along the 800-mile route from the port of Karachi in Pakistan to Kabul. It contains this particularly vivid description of the anarchy that rules the road in Pakistan:

There were no passing lanes or turn signals. No one obeyed traffic laws. The only laws were the laws of physics, of mass and momentum. Everyone was nimble and prepared for sudden, evasive action. The highway was shared by an incredible variety of vehicles and creatures, from late-model cars to barrows drawn by water buffalo. Size and speed determined the pecking order. The top predators were the intercity passenger buses—hulking, rectangular Volvos that could make the trip from Karachi to Peshawar, almost 900 miles in a mere 24 hours. They barreled down the highway with the authority of trains and had distinctively strident, ululating horns. When you heard the din in your ears, you knew you had to get out of the way fast. Next in order were the newer cars and SUVs that threaded recklessly through slower traffic, also bullying a path with their horns. They were followed by the slower cars and vans, battered old Toyotas and Suzukis. Then it was fast trucks, like the empty dump trucks and German-built haulers bound for the steep mountains; next, slow trucks, from the Hinos down to the ancient Bedfords (we were in this category); then, motorcycles, rickshaws, people on bicycles and donkey carts, pedestrians, and livestock.

Not surprisingly, Pakistan's roads are among the most dangerous in the world. But similar conditions can be found in many countries across Asia, Africa and Latin America, and it is the people in the last category—people on motorcycles and bicycles, in rickshaws or on foot—who are the most vulnerable and who are dying in the greatest numbers.

Motorcycles, in particular, have become a major problem in the already crowded cities of Southeast Asia. The annual world growth rate of motorization—that is, the number of motorized vehicles added to the world's roads—has averaged about 1.2 percent a year over the last decade; in Southeast Asia, the growth rate is a staggering 15 percent per year. That means doubling the number of vehicles on the region's roads every five years—and it is motorcycles that are driving the boom.

Manufactured mainly in China and being sold at a rate of about 30,000 a day, these two-wheelers are cheap, noisy, eco-unfriendly and very hazardous to your health. More than a third of all traffic deaths in Southeast Asia can be attributed to them. On the other hand, they have opened the doors of mobility—physical and social—to millions of people who could never afford a car. In Vietnam, where the per capita GDP is a modest $1,160, there are just over half a million cars—and 31 million motorcycles. These vehicles have created job opportunities by enabling relatively poor people to become solo commuters. They allow riders in a hurry to skirt traffic jams. And while designed to carry no more then two people, they've transmuted into family vehicles for couples with two and three children.

Helmets can help and most countries have helmet laws, but helmet standards vary wildly and enforcement is often indifferent, especially when it comes to the two or three passengers who frequently crowd onto these vehicles. Vietnam has strictly enforced laws requiring drivers and passengers to wear helmets and a national quality standard for the helmets themselves—but no linkage between the two. In other words, police can't penalize someone for wearing a substandard helmet. So while nearly everyone wears a helmet, a recent survey found that 82 percent of those helmets flunked the minimum safety test.

The other population most at risk are those on foot. The toll is heaviest in Africa, where pedestrians account for 38 percent of highway deaths. In Kenya, the figure is 47 percent; in Mozambique, it's 55 percent. Highway safety experts have noted a strong correlation between a country's sense of egalitarianism, fair play and regard for the rights of all citizens—and the percentage of pedestrians who are killed by motorists. It is no coincidence, according to the World Bank's Irigoyen, that the highly developed Scandinavian countries—"the most egalitarian countries"—have the lowest percentage of pedestrian deaths.

In all countries, it is young people and especially young males who are most at risk—nearly 60 percent of all highway deaths occur among those aged between 15 and 44; 77 percent of all road traffic deaths occur among men. Low income people—the ones most likely to be on foot or on motorcycles and living in congested areas—are disproportionately affected.

"So often it's the sole breadwinner of a poor family. This has a devastating impact—it can send a whole family into poverty," said Jeffrey Miller, a transport specialist at the Asian Development Bank's regional office in Manila. "One accident—the injury or death of the breadwinner—and kids stop going to school either because the family can't pay or because the kids have to work to support the family. It can have a generational impact."

Between 2007 and 2010, the last year for which global data is available, 88 of the 175 countries surveyed by WHO showed a decline in the number of deaths on their roads—indicating that improvements are possible. These 88 countries, however, tended to be the wealthier countries in which about 23 percent of the world's population lives. For the other 77 percent of the world's population, the statistics were less comforting. In Southeast Asia, road fatalities were on course to increase by 144 percent between 2000 and 2020; for sub-Sahara Africa, the figure is 88 percent, according to World Bank figures.

Fortunately, there is nothing intrinsically "Asian" or "African" about bad driving habits or dangerous roads. For rapidly developing Asian countries, Japan is an excellent role model. Its road safety record in the 1960s and 70s was "terrible," according to the Asian Development Bank's Miller, but Japanese leaders acknowledged the problem and set about fixing it. Lawmakers adopted strictly enforced drunk driving laws that include random breath tests and police checkpoints. The country has also achieved an admirably high level of compliance with its seat belt, child restraint and helmet laws. New highways are engineered with safety in mind, and perhaps most important for a country characterized by crowded urban spaces, Japan has made significant investments in public transport, reducing the potential number of vehicles on its roads. As a result, Japan has experienced a steady drop in the number of highway fatalities. With fewer than 4.5 deaths per 100,000 in population, it now has one of the best driving records in the developed world.

Japan's neighbors are trying to catch up, but this will require political will and public consensus. Earlier this year Philippines President Benigno Aquino III signed a tough new drunk driving law, but in a country where driving drunk is often considered a manly skill rather than a moronic risk, experts agree it will take more than a law to change the mindset.

"It's a question of changing perceptions," said Miller. "The good thing is you don't need 30 years to do this. You can make a major difference very quickly."


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Health Inequities

Health Inequities

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