When you think of how to achieve public-health progress in the developing world, you might think of engineering clean water sources and sanitation to prevent water-borne diseases. You might think of implementing measures to stop the spread of malaria, like mosquito nets. You might think of distributing vaccines, or designing education programs about HIV/AIDS.
What you probably wouldn’t think of is figuring out how to keep people safe from traffic.
And yet it’s road traffic – itself a marker of progress and prosperity in emerging economies – that in 2004 killed more children around the world between the ages of 5 and 14 than malaria, HIV/AIDS, or diarrhea (that’s the most recent year for which we have full data). According to “Safe and Sustainable Roads: An Agenda for Rio+20,” a new report from the Campaign for Global Road Safety, road traffic is the leading cause of death globally for young people between the ages of 10 and 24.
It’s not just children who are being killed, of course. Some 1.3 million people die every year on roads around the world. That amounts to 3,500 people every day. Millions more – 50 million more annually – are injured. And those numbers are probably underreported.
The report, written by Kevin Watkins, a non-resident senior research fellow at the Brookings Institute, is written in sober, measured language. But you can sense, too, the frustration at how invisible this problem remains, even as it stares us in the face:
The sheer scale of the road traffic injury epidemic is not widely recognised. There is a widespread tendency to see that epidemic in terms of isolated and unpredictable events -- as ‘accidents’ that befall unlucky individuals. In fact, there is nothing unpredictable about road traffic injuries. And the ‘road accident’ vocabulary deflects attention from the systemic nature of the risks that claim so many, many lives.
As Watkins points out, the traffic fatality epidemic affects developing countries disproportionately:
Developing countries may have far fewer cars, but those cars are far more likely to kill or maim. With less than 10 per cent of the world’s motorised vehicles, they account for 42 per cent of deaths…. India alone accounts for 12 per cent of total fatalities. But global aggregates such as these can obscure the impact in countries with smaller populations and fewer vehicles. Measured in terms of death rates for every 100,000 people, road traffic injury deaths in Tanzania or Ethiopia are twice as high as in India -- and seven times higher than in the United Kingdom.
Fatality rates among children are typically higher than for the general population. In Bangladesh and Thailand, road traffic fatalities account for 38 per cent and 40 per cent respectively of all child deaths among children aged 10-14 – the single largest cause of death for the age group. Taking developing countries as a group, children aged 5-9 in poor countries are four times more likely to die as a result of road traffic injuries than their counterparts in rich countries.
Soaring rates of air pollution also kill people – another 1.3 million annually, according to the report. And 70 to 90 percent of the lethal pollutants that cause those deaths come from vehicle traffic.
The economic costs of all these traffic-related fatalities, in terms of lost income, lost educational opportunities, and health care expenditures, are massive.
And yet there is no philanthropist stepping in with a huge check to fund prevention of traffic deaths, the way Bill Gates has with malaria, HIV, and tuberculosis.
Instead, world financial institutions have pumped billions of dollars into road infrastructure, while dedicating only a tiny fraction of that to road safety:
Upwards of US $500bn annually is spent each year on road infrastructure. Multilateral development banks and bilateral donors have made the upgrading of road infrastructure a key element in their financial portfolios. Yet the combined level of donor aid for road safety is best described as a pittance. It is estimated at between US$10-25m a year.
There is hope, Watkins finds, in the United Nations’ designation in 2011 of a “Decade of Action for Road Safety.” There is also hope in the relative simplicity of the solutions, including the development of national road safety management institutions; the creation of safer roads with an emphasis on pedestrians, cyclists, and motorcyclists; and the production of safer vehicles.
There is, however, a fundamental inertia as well. Traffic fatalities, Watkins writes, don’t yet figure into the agenda of the Rio+20 United Nations Conference on Sustainable Development, convening next month in Rio de Janeiro. According to him, that is “an act of omission that, in a very literal sense, puts millions of lives at risk.”
Unlike some of the issues that will be discussed at the ‘Rio+20’ summit, there are few unknowns in road safety. Simple, affordable and available interventions can save lives. Urban planners and road engineers need to ensure that cars and pe- destrians are either kept at a safe distance from each other or vehicle speeds are kept very low. Rules on crash helmets, seat belts, speeding and drink-driving have to be enforced. The safety features of vehicles need strengthening. None of this is rocket science. Yet progress has been painfully slow.
If things keep going as they are, according to the report, the numbers of deaths will continue to rise exponentially, reaching perhaps 2 million per year by 2022. If that happens, it will be no accident.