As a new physician in the slums of Karachi and the Himalayan villages of northern Pakistan in the early 1990s, Adnan Hyder treated infectious diseases that rose and fell with seasonal predictability. Summer’s typhoid and cholera yielded to hepatitis A and pneumonia in the winter.
But Hyder found one health threat remained constant: road traffic. With emergency medical services almost nonexistent, victims of car crashes often died before reaching a hospital or clinic. Those lucky enough to make it to a hospital arrived in terrible shape. “It’s not just someone coming in with a broken thumb. They have a broken thumb, a broken wrist, a broken leg, a head injury…” he says.
Until recently, infectious disease—and to a lesser extent chronic disease—monopolized research in developing countries, says Hyder, MBBS, PhD ’98, MPH ’93. “It’s only in the past 5 to 10 years that people began saying, ‘My God, we forgot to measure the impact of road traffic injuries,’” says Hyder, the Leon Robertson Faculty Development Chair in Injury Prevention and an assistant professor of International Health.
That research revealed another public health scourge of the developing world. Of the 1.1 million people who die globally each year from motor vehicle crashes, about 900,000 come from the developing world. People on foot are at a particular disadvantage; up to two-thirds of the traffic deaths in developing countries are pedestrians (see Chart: Gauging the Cost of Injuries in China).
In the next 20 years, it’s estimated that motor vehicle crashes will become the third leading cause of death and disability in the world.
Reasons for burgeoning road traffic injuries in developing countries include: the “traffic mix” of pedestrians, bicycles, motorcycles, cars, and animals sharing the same roads; overloaded buses and other public transportation; selectively enforced rules on seatbelts and speeding; and drivers under the influence of alcohol.
The rising global death toll has attracted policymakers’ attention. In May, Hyder and seven colleagues briefed UN ambassadors and staff from 60 countries. Hyder hopes the United Nations will soon pass a resolution on traffic deaths that will help convince governments to invest in road safety. Hyder and colleagues from the School recently showed that Pakistan spent just 7 cents per capita on road safety in 1998, and Uganda spent 9 cents.
In another encouraging sign, World Health Day—which designates each April 7 as a day to focus on a specific health threat—is dedicated next year to preventing road traffic injuries. Also next year, the World Health Organization will publish a global report on traffic injuries. Hyder is one of the report’s editors.
What isn’t yet known, according to Hyder, is the cheapest, most effective way to reduce road traffic injuries and deaths in the developing world. Interventions such as seatbelts, helmets, reflectors, and speed bumps have been well researched in developed countries, but Hyder thinks these interventions need to be tested within local contexts. For example, adding seatbelts to cars in Uganda will not save many lives if most of the traffic deaths are pedestrians. —Brian W. Simpson