Driving to an early grave

FROM the back of St Mary’s Mission Hospital, two hours north of Nairobi, Kenya’s capital, convalescent patients can watch flamingos frolic on Lake Elementaita. From the front, the view is less idyllic. Overloaded lorries race along the A104, a busy part of the Northern Corridor, east Africa’s main trade route. Each month, says Robert Limo, a researcher at the hospital, at least two patients are readmitted, having been run over just minutes after being discharged while waiting for a bus.

This stretch of road was upgraded in 2008 with funding from the European Union. But almost all the $91m went on asphalt and almost none on safety, so the road that was supposed to make everyone richer has brought grief, too. Cars and lorries now speed by at 130kph (80mph). The road has no provision for overtaking or protection for pedestrians and casualties inundate local hospitals, with two or three a week coming to St Mary’s from a 5km stretch alone. The picture is repeated across Kenya as the country’s roads are upgraded with little thought for safety. Road casualties now account for half of admissions on its surgical wards.

Every 30 seconds someone, somewhere, dies in a road crash, and ten are seriously injured. The toll is rising: the World Health Organisation (WHO) expects the number of deaths globally to reach nearly 2m a year by 2030, up from 1.3m now. But the pain will fall far from equally. Rich countries are making roads safer and cutting casualties to rates not seen for decades, despite higher car use. Poor and middle-income ones will see crashes match HIV/AIDS as a cause of death by 2030 (see chart). In the very poorest, the WHO expects deaths almost to triple.

Where incomes are low, for example in Bangladesh and Kenya, pedestrians top the body count. As they rise, so does the use of motorbikes—often for the precarious transport of entire families. In Thailand motorcyclists are more than two-thirds of fatalities. A bit richer still, and four wheels dominate. In Argentina, Russia and Turkey the main victims are inside cars, buses and lorries.

Higher vehicle standards are a big reason for falling death rates in the rich world. But many other safety measures are simple and cheap. Roads used by pedestrians got pavements and crossings. Fast traffic was separated from cyclists and pedestrians. Governments advertised the need for seat belts and motorcycle helmets, and enforced speeding and drunk-driving laws.

Where safety has been put first, the results have been remarkable. Though a tragic run of crashes has killed three pedestrians and a cyclist in New York in recent days, speed bumps, pedestrian countdown lights and slow zones around schools mean that the city now has fewer deaths each year than when it started counting in 1910. Sweden has halved road deaths since 2000, and cut them by four-fifths since 1970.

But in the developing world, laws and safety measures are failing to keep up with population growth, urbanisation and rising car use. Development banks and donors often make matters worse, says Kavi Bhalla of the Johns Hopkins Centre for Global Health, by paying for new roads that are fast but not safe.

Over one in three road-accident victims are under 30: crashes are the leading cause of death for 15- to 29-year-olds worldwide. Most of the casualties are men and boys, who use roads more, and take more risks. That means that many were breadwinners, or could have expected soon to be.

So crashes take a huge financial toll as well as an emotional one. A dead or maimed 17-year-old costs much more in lost earnings than an 80-year-old. A victim’s family is often plunged into poverty for two or even three generations, says Avi Silverman of the FIA Foundation, a London-based road-safety charity. The International Road Assessment Programme (iRAP), an engineer-led road-safety charity, calculates that road deaths and injuries cost 2% of GDP for high-income countries and 5% of GDP for middle- and low-income countries, including medical bills, care, lost output and vehicle damage—$1.9 trillion a year globally.

Each year $500 billion is spent on new roads. By linking isolated communities to schools, hospitals, jobs and markets, they boost development. But just 1-3% of the construction budget is often enough to make a road much safer, says Rob McInerney of iRAP. And safer roads have much higher returns, says Veronica Raffo of the World Bank.

iRAP has helped to build fences to separate pedestrians from traffic in Bangladesh, at a cost of just $135 to avert a death or serious injury; and installed rumble strips on hard shoulders in Mexico to alert drivers when they are veering from their lane ($920). Telling people about safety laws—and then making those laws stick—can be surprisingly affordable and effective, too. The share of people wearing seat belts in Ivanovo, Russia, rose from 48% in 2011 to 74% in 2012, after a police crackdown and social-media campaign partly paid for by Bloomberg Philanthropies, the foundation of Michael Bloomberg, New York’s former mayor and one of the few big aid donors to spend heavily on road safety. Dan Chisholm of the WHO calculates that enforcing speed limits and drunk-driving laws in South-East Asia would cost just 18 cents per person per year.

In the Nesco school in Kibera, Kenya’s largest slum, the children recently received government-funded vaccinations for measles and polio. And aid donors have pledged $600m to fight HIV/AIDS, tuberculosis and malaria in the country in the next few years, and $4 billion globally. But with multi-lane highways to navigate on the way to school, and a lack of safe crossings, a quarter of the pupils have been in a road crash and a third have seen a close relative injured or killed. A little more spent on road safety would help more children in Kibera, and across the developing world, make it safely into adulthood.