What is the most important thing the U.S. can do to improve global health over the next 15 years?

According to the World Health Organization, road traffic fatalities are one of the leading causes of death in the world, but have only recently been recognized as a public health issue by governments and civil society alike. Similar to most infectious diseases, low- and middle-income countries bear the brunt of road traffic fatalities and have the fewest resources to deal with it effectively. However, road traffic fatalities impact a higher number of young adults than infectious diseases, and are a major barrier to accessing important resources, such as school and hospitals. Thus, the most critical move the United States can do to improve global health over the next fifteen years is to invest in improving road infrastructure and road safety activities in low- and middle-income countries.

As an intern with the Association for Safe International Road Travel (ASIRT), I hear of road traffic tragedies on a daily basis. This morning, I read an article about a car that struck a cyclist and dragged him nine hundred feet down a major road in a town adjacent to mine in Massachusetts. On a Canadian road nine years ago, a friend of mine was killed in a bus that rolled over after the driver took an exit too fast. Kayla, along with three other middle school students, was on her way to a band concert in Nova Scotia when they were thrown from the bus and killed. Fourteen years ago, Rochelle Sobel’s twenty five-year-old son, Aron, was killed along with twenty two other passengers in a bus crash in Turkey. According to police reports, the bus driver was speeding recklessly down the wrong lane of a deteriorating road with no guard rail. The bus collided with oncoming traffic and plunged down a ravine, landing on its side, and medical personnel could not respond in time due to traffic congestion caused by poor infrastructure. As a response to her son’s death, Rochelle Sobel established ASIRT to protect road users and pedestrians around the world.

While we tend to think of road fatalities in terms of individual tragedy, each individual death also amounts to greater implications for national and international development. According to Make Roads Safe, thirty-five hundred people die from road traffic accidents every day.¹ An inordinate number of these deaths—over ninety percent—take place in low- and middle-income countries.² According to Lord George Robertson, chairman of the Commission for Global Road Safety, more children ages five to fourteen in developing countries are killed by road injuries than malaria or AIDS.3 Furthermore, road injuries are the leading cause of death of young people ages fifteen to twenty-nine, who are the primary breadwinners of families.^2,3 The death of young people in low- and middle-income countries has a devastating impact on national economies, costing an average of one to three percent of their gross domestic product every year, which is more than these countries receive in development aid.^{4, 5} As the United States is the single largest donor of foreign aid in the world, it has the unique opportunity to lead the world in creating sustainable global road infrastructure as a means of improving health. Through aid, the United States should require governments to earmark a percentage of funds towards improving road conditions, including, but not limited to, creating pedestrian tunnels; installing guard rails, speed bumps, and clear road signs; and mandating seat belts, child restraints, and helmets. This push from the U.S. government will begin the momentum needed to improve road conditions for motor vehicles and pedestrians alike.

Inherent in improving infrastructure, there will be fewer fatalities and healthy life years lost, a higher gross domestic product, and increased access to important institutions, such as schools and hospitals. Making roads safer will contribute to a healthier population that is less prone to debilitating injury or early death, which can feed into other development efforts. Had the roads been well-built, speed limits enforced, and seat belts available on the day Aron’s bus toppled over into the ravine in Turkey, today he might have been a thirty-six year old doctor, practicing medicine and improving the health of others. Similarly, had law enforcement officials enforced the speed limits and seatbelt laws in Canada on the night Kayla’s bus flipped over, today she would be a healthy twenty-two year old, getting ready to graduate from college. Like Aron and Kayla, millions of young people lose the ability to lead productive lives and contribute to the economic growth of their country due to preventable road crashes. The United States must take action to improve road conditions in the world, and thus, improve global health.

Sources

1. Commission for Global Road Safety. (2009). A decade of action for global road safety. Make Roads Safe. Washington, DC. Date accessed November 20, 2009. <http://www.makeroadssafe.org/publications/Documents/decade_of_action_report_lr.pdf>
2. World Health Organization. (2004). World report on road traffic injury prevention. World Health Organization. Geneva, CH.
3. Robertson, George. (2009). “Terrorism on the roads.” The Moscow Times. 19 November 2009. Moscow, Russia. Date accessed November 20, 2009. <http://www.themoscowtimes.com/opinion/article/terrorismon- the-roads/389866.html>
4. World Health Organization. (2004). World report on road traffic injury prevention. World Health Organization. Geneva, CH
5. Robertson, George. (2009). “Terrorism on the roads.” The Moscow Times. 19 November 2009. Moscow, Russia. Date accessed November 20, 2009. <http://www.themoscowtimes.com/opinion/article/terrorismon- the-roads/389866.html>