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Story Publication logo February 3, 2015

Southeast Asia: Death Rides a Moto


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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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A swarm of motorcycle commuters in Jakarta. Image by Kristianto Purnomo. Indonesia, 2013.

On a typically steamy afternoon in Phnom Penh, Chhay Hour, a 26-year-old engineer who works for Cambrew, Cambodia's largest brewery, has been bargaining hard for a used Honda in the capital's Prampi Makara district, known for its hundreds of used motorcycle shops. This will be his first bike. He used to walk to work from company-provided housing at its main facility near Sihanoukville. But he's been transferred to a new job in the capital and will have to commute about four miles. Hence the need for wheels.

I ask Hour, a lanky fellow with a self-assured air, if he has a license.

"Who needs a license?" he replies with an amused laugh and raised eyebrow. "I have no intention of getting one. It's just a piece of paper. If the police stop you — even if you have license — they will find some way to steal your money. If the police stop you, you just pay."

This attitude — and this kind of petty corruption — is pervasive across Southeast Asia. If the traffic police don't take traffic laws seriously, why should anyone else?

The graft, people seem to think, is just the cost of doing business in a developing economy — a necessary evil that greases the wheels. As one senior police official in Bangkok told me, "People are not complaining about it. If they can buy a police officer, it's much better than the whole tedious process of going through the courts and paying a heavier fine. So they prefer it this way, even if it makes the whole society corrupt."

Only about a quarter of Cambodia's drivers bother to get a license, and a recent survey found that 70 percent of the country's motorists didn't understand the meaning of a simple stop sign. Which might explain why the country is at the head of world's most-overlooked health crisis: the sharply rising death toll that has trailed the developing world's motorcycle boom.

In wealthy countries like the United States, motorcycles typically represent 3 to 5 percent of the vehicles on the road, but a disproportionate 12 to 20 percent of the road fatalities. Across Asia, which is the epicenter of the motorcycle boom, two- and three-wheeled vehicles account for about a third of all highway deaths, with the highest numbers in Southeast Asia. In Cambodia, for example, motorcycle crashes represent 67 percent of all road deaths; in Thailand and Laos it has reached a staggering 74 percent. With the number of vehicles in the region doubling every five years, the number of fatalities is expected to grow commensurately.

On an official level, governments pay lip service to making roads safer and the need to accommodate the growing number of motorcycles, but they appear to view the body count as an unavoidable cost of economic progress. This, however, is a serious miscalculation. According to World Bank estimates, road crashes are costing the economies of Southeast Asia between 2 and 3.5 percent in annual GPD. Loss of productivity due to death and long-term disability (the overwhelming majority of motorcycle fatalities are male breadwinners), the burden on the health care system and property damage are the main factors. Ratnak Sao, a WHO road safety specialist in Phnom Penh, told me that road crashes cost the Cambodian economy $337 million last year. "It's not just the people who are killed," said Sao. "Everybody pays."

A two-stroke tsunami

Between 1908 and 1927, the Ford Motor Company built and sold 15 million Model T automobiles, motorizing the masses and forever changing the way Americans worked, played, and saw themselves. For better and for worse, Henry Ford's revolutionary marriage of technology and marketing transformed the American landscape in ways that continue to define us.

What happened to America in the space of a generation is now happening in Asia and parts of Africa on an even grander scale and at an even faster pace.What happened to America in the space of a generation is now happening in Asia and parts of Africa on an even grander scale and at an even faster pace.

Visit any Southeast Asian city and the scene is similar: Swarms of buzzing motorcycles dart in and out and around the semi-permanent gridlock of cars and trucks and buses. They pop up on sidewalks and zoom insanely down one-way streets in the wrong direction. In a region prone to sudden downpours, they form flash mobs beneath overpasses, blocking traffic on main thoroughfares until the rain passes. Stop signs and red lights are meaningless. Pedestrians get no respect.

Small, inexpensive motorcycles — motor bikes, motor scooters, motos, e-bikes; they go by many names — have taken over the roads of Southeast Asia and much of the developing world. People who used to walk or ride a bicycle now zip, dodge, and weave. For the masses, most of them living below the poverty line, it means they can commute to a better job, live in a better shantytown. Although designed to carry no more than one passenger, the motorcycle has quickly morphed into family transportation. Any Westerner who has traveled in Southeast Asia has probably chuckled (or blanched) at the sight of a family of five crowded onto a small motorcycle, dad driving and the youngest child — helmetless — perched on the handlebars.

About 95 million motorcycles will be manufactured this year, compared to 80 million cars. China's growing middle class accounts for nearly a quarter of the global car market — a breathtaking number — but motorcycles and scooters are rolling off assembly lines and out of showrooms at an even faster rate, with some industry analysts predicting sales of up to 135 million units in 2016. Most of the new cars will end up in rich countries and, by and large, replacing existing vehicles. The vast majority of the motorcycles will be sold in the developing world, and a large percentage of them will be purchased by first-time owners.

Honda, the world's largest manufacturer of small motorcycles, produced some 17 million units in 2014, up from 6 million units a decade ago. But the Japanese giant faces growing competition from China, which is expected to produce more than 20 million units this year. Interestingly, a number of Chinese cities have banned the bikes from all or part their downtowns for a combination of environmental, traffic flow, and safety concerns.

Aside from the maddening traffic congestion that is part of everyday life in so many Asian cities, this mass motorization is generally good news for the developing world.

"They are cheap to buy and to operate. They are low carbon compared to other modes of transport. Minimal energy per person, very efficient and they get you there fast," says Chanin Manopiniwes, a World Bank economist in Bangkok with a particular interest in road safety. "In rural areas, the motorcycle connects villages, it lets you bring your products to market. It takes your kids to school, to the hospital," he says. "It empowers you."

Reaper with a kickstand

But as Chanin and other experts note, there is a downside: motorcycles are deadly. Over the next decade, they are on course to claim — more lives in the developing world than HIV/AIDS and tuberculosis. Motorcycles have been part of the urban landscape in Asia, particularly Southeast Asia, since the late 1950s when Honda rolled out the first of its now iconic Super Cub models. With a four-stoke single cylinder engine the Super Cubs were cheap to both buy and drive. They took the world — including the United States — by storm. ("You meet the nicest people on Honda" was the tag line of a wildly successful 1960s ad campaign in the United States.) More than 87 million have been sold to date, making it the most popular vehicle of all time.

But the real explosion did not hit in Asia until the 1990s and the early part of this century when booming economic growth and the warm embrace of free market ideologies by various regimes put the possibility of cheap motorized transportation within reach of the masses.

In Indonesia, for example, the surge began a decade ago when the economy first opened up and easy credit became available to anyone who had a job. Motorcycles with sticker prices of $1,000 or so could be purchased for a little money down and a modest monthly payment. There are now more than 60 million motorcycles on Indonesia's roads, compared to 8 million cars, one for every five people (including children).

Cambodia experienced a similar growth spurt, going from a total of 43,000 motorcycles on the road in 1990 to more than 2 million today. The boom began in 1993 after free elections ushered in an era of open markets and consumer spending. Over the last decade, the number of motorcycles has been increasing by about 20 percent a year; highway deaths more than doubled during that period.

In Thailand, motorcycles outnumber cars by a margin of nearly two to one; in Myanmar and Indonesia, it's closer to seven or eight to one; in Vietnam, it's a remarkable 57 to one. The numbers are significant because somewhere between Thailand's motorcycle-to-car ratio and Vietnam's there is a tipping point.

In prosperous Bangkok, cars are still the dominant form of transport and motorcycles are seen mainly as a way to beat the city's crippling congestion. If you are in a hurry to get somewhere in Bangkok, you hop one of the city's ubiquitous motorcycle taxis. Meanwhile, in Hanoi and Ho Chi Minh City, motorcycles are pretty much the only way to get around. These will be among the first Asian megacities where the contours of future growth are shaped by the masses on motorcycles.

Greasing the social and political wheels

American Graffiti, George Lucas's classic coming-of-age film set in the 1960s, celebrates the automobile in American culture and its promise of freedom and sexual opportunity. (It also features a stereotypical nerd named Toad on a Vespa scooter, which has actually become something of a luxury brand among the scooter cognoscenti in Asia.) In Southeast Asia, the motorcycle offers the same promise. You may not be able to "park" in one, but at least it affords a young couple an opportunity to escape the inhibiting eyes of the village. Owning a motorcycle has become the essential status symbol for middle-class high schoolers, while clandestine nighttime drag racing and daredevil stunts in broad daylight are growing in popularity on city streets and rural back roads.

The mass motorization in Southeast Asia has also created a new and unexpected political mobilization. "In the spring of 2010, when as many as 300,000 political protesters from Thailand's Red Shirt movement occupied Bangkok's main commercial district, they were helped by an unusual ally: tens of thousands of motorcycle taxi drivers," writes Richard Bernstein in a recent blog for the New York Review of Books. "With their ability to navigate obstructed streets, the motorcycle taxis transported Red Shirt leaders through otherwise barricaded parts of the downtown. And they carried messages, money, and materials to the protesters, including the makings of Molotov cocktails."

This episode ended badly when the military opened fire on the Red Shirt protesters, killing about 70. "But the remarkable involvement of the motorcycle taxi drivers signaled a deep change in Thailand, a new willingness on the part of previously disenfranchised groups to defy authority," writes Bernstein. He notes that ousted leader Thaksin Shinawatra's scheme to license the motorcycle taxi drivers and require them to wear orange vests — the equivalent of a taxi medallion — redefined the relationship between the government and some of its most marginalized citizens. As one driver put it: "Thaksin told us that we pay taxes and, therefore, state officials work for us."

Road rash

For now, motorcycles pose a much greater danger to the people driving them than to the standing political order. According to the World Health Organization (WHO), Thailand, with 38 road fatalities per 100,000 in population, is the world's second most dangerous place to drive anything (the Dominican Republic is first). Other countries in Southeast Asia are not much better.

Prasom Suksawaeng was 21 in 1995 when a crash paralyzed him from the waist down. His spine was broken when he lost control of his motorcycle and slammed into a truck on a busy road in Bangkok. The truck didn't bother to stop. Prasom told me the incident occurred early on a rainy Saturday morning after a night of drunken revelry. He and his buddies were out celebrating Prasom's new job — he had just gotten hired as a driver for Thailand's Royal Household, of all things. The job was supposed to start the following Monday.

Ambulance service in Bangkok is hit-or-miss, so passersby flagged down a pickup truck and bundled Prasom into the back for the ride to the hospital. That probably precluded any chance of his ever walking again.

He recently obtained a bachelor's degree in political science, but his days are mostly confined to a wheelchair, watching television in the cramped apartment he shares with his mother. She bathes him, dresses him, and helps him go to the toilet. He earns a little money as data processor for a charity that tries to raise awareness about drunk driving in Thailand. Since his accident 20 years ago, Prasom says he has lost five close friends to motorcycle crashes. About 26,000 people are killed on Thailand's roads each year, three-quarters of them on motorcycles. In Britain, which has a similar-sized population, the annual death toll is less than 2,000.

"We have an insurgency crisis in the south. Every day, a bomb or a shooting [with] one or two people dead. Big headlines in the newspapers the next day. But at the same time we are having 70 people dead each day on our streets — and nobody is saying anything," says Tairjing Siriphanich, a Bangkok road-safety activist.

"If a robber kills somebody, we are outraged. If people are dying of AIDS, we demand the government do something," says Tairjing. "But if your son or husband or brother dies on the road, we accept it: 'It was his fate, his destiny; it was his time to die.'"

Tairjing and other Thai road safety experts suggested that this fatalistic indifference had its roots in the country's Buddhist traditions and its profound belief in karma. Maybe. But I found similar attitudes in Muslim Indonesia and the devoutly Catholic Philippines.

"I'm a medical doctor. I tried to tell our minister of health that we have a serious public health crisis, but his response is that highway safety is not our job," said Tairjing. "I tell him, 'Look, you give out free condoms to prevent AIDS. Why not give out free helmets?' Two hundred baht (about $6) for a decent child's helmet. A million children a year. That's not a big deal."

Wearing a helmet would be an obvious first step. All countries in Southeast Asia have mandatory helmet laws — at least for drivers, if not always for passengers — but the laws are lightly enforced and largely ignored. In Cambodia, the fine for not wearing a helmet ranges from less than a dollar to $4, depending on whom you ask. One survey in Kampong Cham province — a few hours north of Phnom Penh on a very treacherous road — showed that only 24 percent of drivers wore helmets during the daytime, with that figure dipping to 5 percent after dark.

Many motorcyclists who wear helmets do so only to avoid paying petty bribes to corrupt traffic cops, and the helmets they are wearing are so poorly made as to be virtually worthless in a crash. In Vietnam a study found that more than 80 percent of the helmets being worn by motorcyclists failed to meet minimum safety standards. Ratnak Sao, the WHO road safety specialist in Cambodia, told me he bought a helmet in a Phnom Penh street market for about 80 cents — and then crushed it with his hands.

While carnage on the roads in Cambodia and elsewhere in Asia is clearly a serious public health crisis, donor-driven spending hardly reflects the urgency. According to WHO statistics, there were about 2,300 HIV/AIDS-related deaths in Cambodia in 2012 compared to almost 2,000 highway fatalities, yet spending on HIV/AIDS treatment and prevention campaigns totaled $58 million compared to just $10 million for road safety improvements; malaria claimed about 100 lives in Cambodia that year but received $42 million in funding, while a celebrity-laden demining campaign spent $20 million even though only about 100 people a year are killed by landmines.

Earlier this month, Cambodia's King Norodom Sihamoni signed a new set of road safety laws that, among other things, limits the number of people on a motorbike to one driver, one adult passenger, and one child. It also requires all passengers older than age 3 to wear a helmet. The laws are supposed to take effect next month, but as Ratnak and other road safety activists have noted, actual enforcement may be years away.



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Health Inequities

Health Inequities

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