Understanding the Iinkages between road

traffic accidents and economic

modernization: an inter-country anaIysis


Presented by Godwin Sree Kulakkal, Student, Achutha Menon Centre
for Health Sciences, Sree Chitra Tirunal nstitute for Medical
Sciences and Technology, ndia





















1 November 2006
Presentation made at Forum 10, Cairo, Egypt, 29 October - 2 November 2006

2
Interlinking economic development and road traffic accidents: An inter-country
analysis

Godwin SK
1

2

Background: Road traIIic accidents are generally considered as price oI material
progress oI human beings. When the economic structure oI a country changes Irom
predominantly agricultural to industrialised and service oriented. income oI the
population increases and expansion in modern amenities and consequent vehicular
accidents and casualties are inevitable. This oIt-heard argument in the context oI
discussions on the prevention and road saIety is detrimental to the eIIorts in controlling
road accidents.

Objective & Methods: Understanding the linkages between modernisation oI the
economy and its linkages with road traIIic accidents. It also attempts to assess the
diIIerential impact oI RTAs on diIIerent socio-economic groups. An analysis oI incidence
oI road traIIic accidents was conducted across diIIerent countries (using oIIicial statistics)
at various stages oI economic development with an added emphasis on Indian context.

Results: The interesting Iindings include: Firstly. countries and regions with predominant
agricultural activities and less secondary and tertiary sectors have been Iound to have less
RTAs. Though economic development is positively correlated with RTAs. the victims oI
RTAs are manual labourers. vendors and low-income groups. Secondly. experience oI
high-income countries or highly motorised countries shows that with concerted eIIorts
the above relationship could be reversed. Thirdly. the notion that rich people in lower and
middle-income countries bear the burden oI RTAs is at the best. a conspicuous myth.

1
PhD Candidate (Senior Research Fellow). Achutha Menon Centre Ior Health Science Studies. Sree Chitra
Tirunal Institute Ior Medical Sciences and Technology. Trivandrum. Kerala- 695 011 INDIA. E-MAIL:
godwin(sctimst.ac.in. godwinsk(yahoo.com

2
Lecturer in Economics. K.N.M Government College. Kaniiramkulam. Trivandrum. Kerala 695 524.
INDIA.
Presentation made at Forum 10, Cairo, Egypt, 29 October - 2 November 2006

3
Low educational levels. poorly paid occupations and income poverty are being Iound as
important risk Iactors Ior RTIs. More results oI the detailed analysis would be presented
during the seminar.

Discussion on Policy Implications: All countries undergoing structural transIormation
(especially middle and low-income countries) would have to Iace a higher burden oI
RTAs in Iuture and victims may predominantly be the breadwinners oI poor households.
There is an urgent need Ior measures to protect against huge income shocks so as to
protect the consumption and livelihood. lest it may lead to Iundamental inequalities (oI
income and wealth). Any individualised health care Iinancing mechanism based on
ability to pay wound tend to worsen the aIIected especially the poor. women and the
elderly.





Paper presented at the 10
th
Annual ConIerence oI Global Forum Ior Health Research
(Forum 10) held between 29
th
October 2
nd
November 2006 in Cairo. Egypt.












Presentation made at Forum 10, Cairo, Egypt, 29 October - 2 November 2006

4
Interlinking economic development and road traffic accidents: An inter-country
analysis

Godwin SK


Context

Human beings` material progress has attained unprecedented heights especially
during the last century largely promoted by his/her increasing physical mobility. The
change in pattern oI mobility is necessitated by a general transIormation in the economic
structure oI a country Irom predominantly agrarian and Ieudal to industrialised/tertiary
sector oriented. However. the mobility has not been costless and over the decades. the
world has lost millions oI human lives. It is estimated that more than 30 million
individuals lost their lives and the hopes oI the 30 million`s dependants perished on roads
since the Iirst pedestrian casualty reported in 1898 (IFoRCaRC 1998). A lion`s share oI
this wastage oI lives could have been avoided. indeed. It is also important to note that the
distribution oI iniury burden is not uniIorm across countries and populations and severely
against the low income countries and individuals Irom low social and economic structure.
Even an untailored look at the global scenario oI road transport growth (mobility) and
road place casualties would take one to conclude that there exists wide inequalities in the
beneIits and costs oI mobility with inter and intra-country dimensions. It is seen Iurther
that the beneIiciaries do not always carry the costs oI their actions and merely classiIying
the costs as 'economic externalities would amount to oversimpliIication oI a complex
issue.


Statistics point out that there is direct relationship between per capita income
growth and road related casualties up to a certain limit and high-income countries have
surpassed the stage and low and middle-income countries (LMICs) are passing through a
dangerous phase oI Iast rising road casualties. Nearly 80 percent oI the global road
accident related deaths occur in developing countries whose share in global vehicle
Presentation made at Forum 10, Cairo, Egypt, 29 October - 2 November 2006

5
population is less than 75 percent implying that they bear a disproportionate burden oI
deaths and disabilities due to RTAs in 2000. The Iatality rate is 70 per 10000 vehicles
25 times higher than Ior any developed country (Khan 1997) implying that lot more
needs to be done in the reduction oI passenger saIety mechanisms in the vehicle as well
as in the post-accident trauma care services in poor countries. The total number oI road
traIIic Iatalities and iniuries is Iorecast to rise by some 65 between 2000 and 2020
(Murray & Lopez 1996; Koptis & Cropper 2003) and in low and middle income
countries. deaths are expected to rise by about 80 . On the contrary. they are expected
to come down by 30 percent in high-income countries (Peden et al 2004). According to
the World Bank`s TraIIic Fatalities and Economic Growth (TFEG) proiect. between 2000
and 2020. South Asia is predicted to record a 144 increase in road traIIic Iatalities. II
the LMICs Iollow the general trend oI rich industrialised countries. the Iormer`s Iatality
rates will begin to Iall in the Iuture. but would cost immensely. As per the model`s
predictions. India is anticipated to start its decline in road traIIic related Iatality rates aIter
2042. The broader message oI these predictions is that should current trends move on and
new eIIective interventions are not undertaken. then more casualties will be experienced.

Table 1: Growth of road accidents in selected countries. 1990-1997

Number oI accidents during Country
1990 1997
Growth rate during 1990-97
Austria 46338 39695 -14.3
Belgium 62446 49007 -21.5
Bulgaria 6478 6018 -7.1
Canada 182294 158973 -12.8
France 162573 125200 -23.0
Germany 340043 380835 12.0
Hong Kong 15255 14776 -3.1
Hungary 27801 19004 -31.6
India 282602 290855 2.9
Japan 643097 780399 21.4
Netherlands 13247 11238 -15.2
Pakistan 13683 5905 -56.8
Poland 50532 66586 31.8
Singapore 6871 6943 1.1
Spain 101507 86607 -14.7
Sweden 13675 15752 15.2
Presentation made at Forum 10, Cairo, Egypt, 29 October - 2 November 2006

6
Switzerland 22956 22076 -3.8
USA 2540946 2222280 -12.5
Source: International Road Federation

Table 2: Road traffic injury mortality rates per annum (per 100 000 population) in
WHO regions. 2002
WHO Region Low and middle-income
countries
High-income
countries
1 AIrican region 28.3 ---
2 Region oI the Americas 16.2 14.8
3 South-East Asia region 18.6 ---
4 European region 17.4 11.0
5 Eastern Mediterranean
region
26.4 19.0
6 Western PaciIic region 18.5 12.0
Source: Peden et al. 2004


The aIoresaid Iacts and Iigures raise some important and critical questions. How
does one explain relationship between road traIIic accidents and Iatalities vis-a-vis
economic growth across developing and developed societies? Is the trend natural and
should we allow the trend to carry Iorward as a matter oI luck and destiny? Who are the
beneIiciaries oI income growth and who are at the receiving end? What are the lessons
we need to learn Irom the societies which reversed the so-called trend rather than
allowing the countries to cost lives? How does one address the issue oI road related
casualties in the context where societies are Iundamentally divided among economic
lines? The present paper addresses a Iew oI these initial questions and especially
discussing the relationship between economic growth (the positive and substance increase
in the income oI a given population and government) and incidence oI road traIIic
accidents especially oI road related Iatalities Iorms the maior agenda oI this paper. The
issues would examine the conceptual arguments explaining the above questions Iorm the
Iirst part. Secondly. the paper discusses Iindings oI the study in relation to the existing
literature.

Conceptual hypotheses
Presentation made at Forum 10, Cairo, Egypt, 29 October - 2 November 2006

7

Studies have recorded a biphasic relationship between the incidence oI road
traIIic casualties and economic progress with casualties rising Ior the low-income
countries and declining Ior the industrialised countries (van Beeck. Borsboom &
Machenbach 2000). Why there exists an inverted U-shaped relationship between
incidence oI road accidents and economic development has been a question oI perennial
interest among researchers. The reasons are not Iar to seek: a number oI complementary
and competing explanations are at work. In a primitive society agriculture is the mainstay
oI livelihood Ior the maiority and most oI it is used Ior own-consumption (subsistence)
and not much marketable surplus is generated. However. in the later stages.
commercialisation oI agriculture (production oI agricultural goods Ior the market)
necessitates mobility oI Iactor inputs and outputs requiring expansion oI roads and
vehicles in a given society. Since modernisation oI agriculture requires industries to
supply large number oI inputs like Iertilisers. equipments. etc and processing oI agri-
goods. industrial sector also gains momentum leading to an enhanced pace oI growth oI
motor vehicles and their paths. The tertiary sector (banking and Iinancial services.
communication. insurance. computer soItware etc) acts as a lubricant in the process oI
agricultural and industrial expansion and tertiary sector requires the Iast movement oI
goods & services. II no eIIective measures are taken. casualties resulting Irom the
movement oI traIIic would be the highest when industrial and service sector attains a very
high rate oI growth. Now let us see what happens to the type oI motor vehicles on the
roads. In the Iirst phase when agriculture was the mainstay oI the economy. individuals
used to possess slow moving vehicles including vehicles requiring manual eIIort like
cycles. cycle-rickshaws. bullock-carts. etc as they are cheaper with less priority Ior saIety
measures. In the Iirst stage. road accidents and associated casualties would be the
minimum which is primarily due to the low speed. With technological progress. the
mobility gets enhanced by sophisticated vehicles and rate oI road casualties increases
uninhibited.

The existing diIIerent strands oI literature trying to understand the history oI road
accidents and economic development may be classiIied under Iour maior explanations.
Presentation made at Forum 10, Cairo, Egypt, 29 October - 2 November 2006

8
Coase`s theorem constitutes the origin oI externalities argument in which any
externalities problem could be eIIectively solved iI we are able to accurately assign the
property right to create problems (road accidents) and then costlessly traded and he
sincerely believed that a matured market economy is a Iine way to do that (Coase 1960).
It is thus argued that regulation oI externalities and its IruitIul assignment oI liabilities are
possible generally only at advanced stages oI economic development when the
institutional arrangements attain maturity. The contributors oI externalities include the
manuIacturers oI vehicles. insurance companies. enIorcement agencies etc and the
absence oI an eIIective institutional Iramework means that the contributors oI accidents
are not accounted Ior. Here. Vickrey (1968) stresses emphatically the speciIic role oI
motor-insurance policies in risk-taking on roads.

The second theoretical stream emphasises the role oI low investment in road
saIety in low-income countries. The low priority attached to prevention oI road saIety
mechanisms is primarily based on the notion oI cost-eIIectiveness oI public health
interventions and the belieI that road accident victims are not generally poor. The cost-
eIIectiveness argument bases its arguments reasoning that resources be allocated in such
a way that the marginal returns Irom spending on prevention or curation oI disease should
be maximum Ior a given unit oI resource spent. With increased income Ior countries. they
can earmark a greater proportion oI resources towards road saIety and passenger security.
The political economy behind the increased allocation may be attributed to the increased
wield that the upper and middle income groups they possess.

The so-called vehicle mix hypothesis points out that the eIIect oI economic
growth on the changing mix oI vehicles on the road (Tay 2003) need not be always
positive Irom the road accident`s point oI view. Individuals. with income growth. preIer
convenience to mass transport means the Iormer are more vulnerable to road accidents.
The vulnerability is more iI the personal vehicles are two wheelers whose probability oI
meeting with an accident as well as Iatalities is many times higher than other maior
category oI vehicles.

Presentation made at Forum 10, Cairo, Egypt, 29 October - 2 November 2006

9
The Iourth hypothesis on the relationship between road accidents and economic
development elicits the role played by an eIIective pre-hospital emergency services and
trauma care systems. Improved investments in trauma care and pre-hospital care are
positively correlated with higher survival in a large number oI places (Adam et al 1994;
Arreola-Risa et al 2000). Thus. it is observed that despite Iast increasing volume oI
traIIic. road traIIic accidents decline at the pragmatically advanced phases oI economic
development probably due to a combination oI Iactors including a higher preIerence
towards quality on roads including better roads. the saIety oI travellers and vehicles.
creation oI a suitable legal Iramework and an eIIective enIorcement oI road rules. etc.
Bishal et al hypothesise that investment in harm reduction. improvements in emergency
transport and timely and adequate medical treatment oI victims reduced Iatalities despite
increased crashes and iniuries (Bishai et al 2006).

Methods

A number oI countries have been selected based on the stage oI economic
development and occupational structure and incidence oI domestic road accidents. Data
Irom National Crime Records Bureau. Road TraIIic research agencies were analyzed and
a structured review oI existing published and unpublished documents was undertaken.
The income data Ior the States have been taken Irom the Economic Survey oI
Government oI India. Economic Reviews Irom concerned States etc.

Results

Firstly. countries and regions with predominant agricultural activities and less
secondary and tertiary sectors have been Iound to have less RTAs. Though economic
development is positively correlated with RTAs. the victims oI RTAs are manual
labourers. vendors and low-income groups. Districts. regions as well as countries that
have a lower share oI income deriving Irom agriculture. a lower share oI population
dependant on agriculture tend to have lower incidence oI road accidents. This is primarily
due to the lesser number oI vehicles rather than any concerted eIIort intended to prevent
Presentation made at Forum 10, Cairo, Egypt, 29 October - 2 November 2006

10
the volume oI accidents and Iatalities. Since productivity is lower in agriculture. income
per capita oI agriculture dependant population would also be low and hence have less
amenities to wallow.

Secondly. experience oI high-income countries or highly motorised countries
shows that with organised eIIorts. the above relationship could be reversed. Table
highlights that low income countries do not have any respite Irom this modern scourge.

Table 3: Changes in road traffic fatality rates (deaths per 10 000 population). 1975-
1998
Country or Area Change ()
Canada -63.4
China
Hong Kong SAR -61.7
Sweden -58.3
Israel -49.7
France -42.7
New Zealand -33.2
The USA -27.2
Japan -24.5
Malaysia 44.3
India 79.3
a
Sri Lanka 84.5
Lesotho 192.8

Colombia 237.1
China 243
Botswana 383.8
b

SAR: Special Administrative Region
a
ReIers to the period 1980-1998
b
ReIers to the period 1976-1998


Finally. the poor and vulnerable road users are at greater risk oI road accidents were
supported by many studies Irom developing countries. In the process oI development and
modernization. oIten the ones who suIIer death and disability are not the rich. but the
lower income groups. OIten the latter constitute the vulnerable road users. Lower socio-
economic status and individuals living in poorer areas is Iound to be a maior risk Iactor in
RTAs and this risk is primarily not due to behavioural Iactors. but mostly to deviations in
Presentation made at Forum 10, Cairo, Egypt, 29 October - 2 November 2006

11
exposure to risk (LaFlamme 1998). Foremost. a Pakistani hospital-based case-control
iniury survey brought out that 71 percent oI the child victim households were having an
annual household income oI less than Rs. 3000 (US$ 67) and children whose mother was
not educated and houses with minimum Iacilities were at greater risk oI traIIic iniuries
than their better-oII counterparts. A study Irom Kerala. India brings out more interesting
but disturbing evidence that the vulnerable road users (pedestrians. pillion riders. cyclists
etc) constitute 67 percent oI the RTA victims. More than 63 percent oI the victims were
lower income groups having less than one USD (Rs.44) per day. By occupational groups.
maiority (75 percent) were inIormal workers including manual labourers. selI-employed
and dependents who do not have any Iormal means oI protection against such
catastrophic events aIIecting their livelihoods. Seventy-three percent belonged to 20-60
age group which wipes out the already thin productive resource in the poor households
(Government oI Kerala 2004; Godwin 2006). In Kenya. more than 75 oI road traIIic
victims belong to economically productive young adults (Odero et al 2003). The choice
oI transport oI the population is. as apparent. is dependant primarily on economic
capacity and so. the low-income groups tend to travel by means having higher levels oI
exposure to road accidents. In Kenya. a case in point is that 27 oI commuters had no
Iormal education Iound to travel on Ioot. 55 utilised buses/minibuses while around 8
used private cars. On the contrary. 81 oI those with secondary education generally ply
by private care (Nantulya & Reich 2002). Studies also point out that drivers with low
status occupation and lower education levels. children oI manual labour etc have a higher
iniury risk (LaFlamme 1998; Whitlock G et al 2003). By region. in south Asian countries
maiority killed. iniured and disabled are pedestrians. cyclists. pillion and motorised two-
wheelers |collectively called vulnerable road users| (Mohan 2002) which Iurther cements
the Iact that the low-income groups are oIten not the beneIiciaries but victims oI income
growth Ior some.



Discussion on findings

Presentation made at Forum 10, Cairo, Egypt, 29 October - 2 November 2006

12
The probability that road users Iall victims in road traIIic crashes is the lowest in
the initial phases and attains very high momentum till it reaches a stage oI middle income
country`s development status and starts diminishing at the higher end oI economic
development. History says that in coniunction with increase in personal incomes and rise
in vehicle population. many high-income countries experienced Iast increase in road
accidents and Iatalities in the Iirst halI oI 20
th
century and reduction in certain counts in
the latter part (Peden et al 2004). However. the changes in the casualties are not
unintentional and record oI those societies which reduced road traIIic casualties show that
they have mainstreamed prevention oI road traIIic accidents in their public agenda.

Road traIIic accident victims have a higher case-Iatality rate and case-severity
rate reIlected by the high incidence oI Iatalities associated with roads and length oI
hospitalised treatment. For instance. a study in India Iinds that iniury had the longest
duration oI hospitalisation aIter neoplasm (Gumber 1995). Accidents/iniuries account Ior
2 percent oI the entire outpatient cases in the country costing each episode 500 rupees
(per case) (the highest among all diseases) and 4 percent oI ambulatory care spending. In
case oI hospitalisation. accidents/iniuries take 16 percent oI all in-patient cases costing
each treatment 9700 rupees and 19 percent oI all IP spending (aIter acute inIections.
iniury/accidents. and second largest burden on household Iinancing). In Kerala. India the
severity oI the accidents is comparatively high in the state as more than 60 percent oI the
victims sustained serious iniuries and around 70 percent oI the victims had permanent
disabilities (Government oI Kerala 2004. Godwin 2006) also pointing to the huge
Iinancial burden oI treatment and disability imposed. In developing countries. the
Iinancial burden oI prolonged medical care. Iuneral expenses. loss oI the household
breadwinner. loss oI income due to disability can push Iamilies into poverty (Hiiar.
Vazquez-Vela & Arreola-Risa 2003).

Implementation oI wide range oI road saIety measures. including helmet use. seat
belt use. vehicle crash protection. traIIic calm interventions. accessible emergency trauma
care and traIIic law enIorcement (Jacobs et al 2000; Lamm et al 1985) have been
attributed to the reduction in road traIIic accidents and Iatalities in high-income countries.
Presentation made at Forum 10, Cairo, Egypt, 29 October - 2 November 2006

13
Had road traIIic accidents been the price oI material progress the high-income countries
should be having the highest incidence oI road casualties. However. this is not the case;
rather there has been a sharp decline in the incidence in highly motorised countries
particularly in road traIIic mortality primarily contributed by improved trauma care.
eIIective enIorcement oI traIIic rules. better vehicles and higher quality roads etc.

Road accident is also a question oI inequality on roads. The complexity in the
vehicle mix oI the developing countries is a reIlection oI widespread inequality existing
in the society in which the victims are oIten the lower socio-economic groups. In other
words. complexity oI traIIic enhances the risk oI accidents and more oIten the victims are
vulnerable road users including two-wheeler riders. and pedestrians. From an economic
point oI view. which population group constitutes the victims is an important question as
their vulnerability to RTAs is very much inIluenced by the nature oI work. In societies
with increasing inIormalisation oI the labour class especially in primary and tertiary
sectors. the impact oI road casualties would be increasingly Ielt on the inIormal labour.
More equity oriented issues cry Ior a debate here. For example. evidence Iorthcoming
suggest that the improvements in road design and legislative measures undertaken in
developing countries generally tend to ignore the vulnerable road users like pedestrians.
cyclists. two-wheeler riders etc and as a consequence they bear a disproportionate burden
oI casualties (Peden et al 2004). while the beneIits in the improvement are accumulated
to car users and other advanced motorised vehicles. Any road policy needs to take into
consideration the equity dimensions in the design oI roads. especially by respecting the
rights oI slow-moving vehicles.

Assuming that maiority oI the accidents are avoidable. still a section oI accidents
might continue to happen and then arises the question oI Iinancing health care oI the
iniured. As widely known. uncertainty in incidence oI and recovery Irom iniury makes
rational decision making diIIicult. Since curative medical expenditure by households
Iorms one among the large number oI inputs contributing to the health status oI an
individual. the opportunity cost oI such spending in terms oI Ioregone Iood consumption.
savings. loss oI assets Ior livelihood. lost wages etc would be very high especially Ior
Presentation made at Forum 10, Cairo, Egypt, 29 October - 2 November 2006

14
lower income groups. Emergency health services is a case where the wedge between ATP
(ability to pay) and WTP (willingness to pay) becomes the maximum implying that the
mainstream assumptions oI economic theory stand questioned. Providing care with
minimum barriers (both price and non-price) to utilisation is iustiIied so that the equity
and eIIiciency loss is minimised (Godwin SK 2006). Who will assume responsibility as
to take care oI the iniured: whether government (state) or individuals themselves
(market). II the latter is allowed to take charge oI the treatment costs. it is certain to
worsen inequalities among the victims and general population. UnIortunately. in maiority
oI the low-income countries. the latter is the norm though. government health Iacilities
provide health care to a large maiority. For example. Ior iniuries more than 60 percent oI
the victims sought hospitalised medical care Irom public health care institutions
compared to less than 36 percent Ior IP care Ior general illnesses including iniuries
(Gumber 1990) indicating the medico-legal issues involved and the Iinancial burden
consequent upon iniuries. Individualistic Iinancing mechanisms are inadequate tools in
many contexts especially so in poor and middle-income countries. Though there exists
very inadequate number oI studies bringing about the economic impact oI road accidents
at the household and individual levels. the disability Iorced withdrawal Irom labour Iorce.
and treatment costs are too unbearable to many. Out-oI-pocket payments would be a
brawny barrier in seeking treatment and Iollow-up.

Conclusion

The term 'accident implies an event that is unavoidable. unpredictable and
inevitable (Peden et al 2004) and in reality maiority oI our road accidents are avoidable.
predictable and escapable. iI the developed country experiences are any guide. Road
related casualties as 'disease oI development views are not to be encouraged anymore.
Developing country road accidents are a complex issue having not only multi-sectoral
dimensions. but also intricate are the wide diIIerentials in the entitlements oI the
population using roads. The Iormer can be changed with lesser eIIort by technological
and behavioural interventions; however. the latter are intrinsic problems associated with
Presentation made at Forum 10, Cairo, Egypt, 29 October - 2 November 2006

15
the risks held by the population. Since the latter`s behaviour and occupational risks are
unambiguously related to the occupational Ieatures and living conditions and so on.

The paper Iinally raises some important questions on the appropriateness oI
introduction and utilisation oI vehicles in a country. BeIore opening up oI domestic sector
Ior Iree entry oI cars made in industrialised countries. it is also imperative to assess the
possible eIIect such an action would have on the roads and other road users in the
domestic sector. One oI the maior Iactors contributing to the widespread inequity in low-
income country roads is the increasing use oI vehicles mostly driven in highly motorised
country situations. There exist very limited length oI roads in low-income countries
which suits the optimum speed oI highly sophisticated vehicles and in such a situation.
the rate oI accidents is expected to go up Iaster and more oIten the losers are vulnerable
road users`. In this context. it should be worthwhile to undertake studies examining the
relationship between the proportion and impact oI new generation vehicles. among other
things. in developing countries and road related casualties. However. in the era oI
liberalising trade policies that back unbridled opening up oI domestic sector Ior Ioreign
goods including vehicles. the extent oI consideration oI the issue oI appropriateness oI
vehicle technology by policy planners is a billion dollar question.

The maior agenda Ior Iuture research need to be on equity on roads and road
sides. Bearing the burden oI disease by any socio-economic groups is an undesirable
situation. As Iar as road accidents are concerned. the situation is a double whammy Ior
the ones in lower echelons oI social order. Here the beneIits go to the richer ones and
oIten the victims are the slow movers in the road called vulnerable road users. travellers
in mass transport etc. Also. undertaking studies on the issue oI equity on roads especially
in low-income countries where the conventional techno-centric approaches may probably
be Iated to Iail because oI the inability oI such an approach to incorporate the social space
in which road accidents occur. It is high time we Iixed responsibilities Ior the individual
actors involved Irom all including the governments. the private sector and the general
public.

Presentation made at Forum 10, Cairo, Egypt, 29 October - 2 November 2006

16
The political leadership in developing countries need to be much more
conscientious especially in picking decisions regarding the peripherally ideologically
neutral questions. II analysed in-depth. the colour oI the decision would be clearer and
give an idea as to who beneIits and who the losers are. In developing countries. lack oI
strict implementation oI road rules is a reIlection oI inadequate government Iinances.
widespread corruption and poor governance prevailing in these countries. As mentioned
elsewhere. due to weak regulatory mechanisms and institutions to assign liability Ior the
users. the vehicles which create a high degree oI negative externality need to be kept
away Irom the domestic market or their use regulated stringently.



The author individually thanks the Global Forum Ior Health Research Ior providing
generous Iinancial support to present the paper at the Forum 10 in Cairo. Egypt during
29
th
October 2
nd
November 2006.



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17

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