{"id":190,"date":"2026-05-26T11:06:54","date_gmt":"2026-05-26T11:06:54","guid":{"rendered":"https:\/\/americanlivingreport.com\/?p=190"},"modified":"2026-05-26T11:06:54","modified_gmt":"2026-05-26T11:06:54","slug":"the-shocking-death-toll-of-cars-in-poor-countries","status":"publish","type":"post","link":"https:\/\/americanlivingreport.com\/?p=190","title":{"rendered":"The shocking death toll of cars in poor countries"},"content":{"rendered":"
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The story of global health over the last few centuries has generally been one of great progress \u2014 vastly longer lifespans, far fewer women dying in childbirth, many fewer children dying from miserable diseases like measles and smallpox. But there is one often overlooked feature of modernity that has brought a new and enormous degree of mortality and injury to everyday life, a risk that falls most heavily on the world\u2019s poor. It kills about as many people as the world\u2019s deadliest infectious disease \u2014 tuberculosis \u2014 and it\u2019s the leading cause of death globally for people in the prime of their lives, aged 5 to 29. It is one of the defining technologies of modern life, one of the 20th century\u2019s most dangerous gifts: the car.<\/p>\n

Read more Should you feel guilty for killing the bugs in your house?<\/a><\/p>\n<\/div>\n

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Around 1.19 million people globally are killed by road crashes every year, according to estimates from the World Health Organization (some estimates put the number higher), and many times more \u2014 likely between 20 and 50 million \u2014 are injured, sometimes leaving them with life-altering disabilities. More than 90 percent of those deaths occur in low- and middle-income nations, although these countries contain only around 60 percent of the world\u2019s cars.<\/p>\n<\/div>\n

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This century, humanity has halved the mortality rate for children under five and reduced AIDS-related deaths from their peak by 70 percent. But the number of people killed by cars has remained the same for the last 20 years. As motor vehicles spread around the world \u2014 the total fleet has doubled over the past 20 years \u2014 the burden of those deaths has shifted increasingly to lower-income countries. Despite all the progress we\u2019ve made against ancient natural killers, we\u2019re making little against a killer we engineered ourselves.<\/p>\n<\/div>\n

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That\u2019s not for a lack of known solutions, but rather because there\u2019s been comparatively little attention paid to car crash deaths as a real global health issue until relatively recently. Unlike deadly maladies that are purely bad, cars do add value to society. Perhaps as a result, even though wealthy countries have brought down per capita road fatalities over the course of decades, deaths by car have still often tended to be discounted by policymakers and the general public as the price of progress and economic growth. It\u2019s \u201cone of the few public health problems where society and decision makers still accept death and disability on such a large scale as inevitable,\u201d the late Dinesh Mohan of the Indian Institute of Technology in 2019.<\/p>\n<\/div>\n

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\u201cYou can become very depressed,\u201d James Leather, director of transport at the Asian Development Bank, told me in a recent conversation at the International Transport Forum summit (an event sometimes called the Davos of transportation). \u201cWhy is no one taking this seriously?\u201d<\/p>\n<\/div>\n

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Of course, it\u2019s not that literally no one is taking it seriously, but rather that cars have long been an underrated threat to human well-being. But that is, perhaps, slowly beginning to change.<\/p>\n<\/div>\n

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Why cars kill so many people in countries with so few of them<\/strong><\/h2>\n<\/div>\n<\/div>\n
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I am sometimes known as a bit of a car hater, devoting a lot of my consciousness to thinking about how the United States got locked into car dependence. Our car-oriented development pattern is part of the reason the US has one of the of any wealthy country. (But, listen, I own a car too, and benefit greatly from it! I am American, after all.)<\/p>\n<\/div>\n

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US car fatality rates may be an outlier by wealthy-country standards, but most low- and middle-income nations face far greater risk. Haitians and Ethiopians are more than three times more likely to be killed by a car than an American; Kenyans, Bolivians, and Thais are more than twice as likely.<\/p>\n<\/div>\n

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That alone is worth dwelling on. If you live in the US, consider that you probably know at least several people who\u2019ve been killed in a car crash or who have loved ones who have, and that this proximity to sudden, violent loss is felt even more acutely in most of the world. Road deaths account for around 1 percent of all deaths in the US; globally, that figure is about 2 percent, and in a typical middle-income country like Vietnam, it is more than 3 percent.<\/p>\n<\/div>\n

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That might sound a bit surprising \u2014 and feels all the more unfair \u2014 in light of the fact that poorer nations do not have anywhere close to as many cars as wealthy ones do, and their residents travel fewer miles by car than people in rich countries do. If cars kill so many Americans because we simply drive so much, in the developing world, the problem is almost the inverse: A minority of people who can afford it ride in private cars, while everyone else walks, bikes, or rides a motorcycle, scooter, or three-wheeled vehicle like an auto rickshaw. And those outside of an automobile \u2014 known as \u201cvulnerable road users\u201d \u2014 often share space in the road with cars and are at high risk of being hit.<\/p>\n<\/div>\n

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Cars themselves in developing nations are often more dangerous for their occupants than vehicles in rich countries are, too. Weaker car safety standards and a reliance on imported old cars mean that people sometimes travel in vehicles that lack safety features long taken for granted in rich countries, including airbags and frames designed to absorb the force from a crash.<\/p>\n<\/div>\n

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Amid all this, cars and other motorized vehicles are spreading rapidly in the Global South \u2014 much more quickly than that transition took place in North America and Europe \u2014 and doing so before governments have built safer roads, vehicle standards, adequate trauma care, or robust traffic regulations. Many nations lack comprehensive laws governing what the WHO considers the five key behaviors that shape road fatalities: high speeds, drunk driving, seatbelt use, helmet use for motorcyclists, and child restraints in cars.<\/p>\n<\/div>\n

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In Southeast Asian countries, which have seen a massive proliferation of motorized vehicles since 2010, \u201cmaybe the infrastructure was designed when you didn\u2019t have so many cars, and now all of a sudden you have twice the number of cars that you did before,\u201d Nhan Tran, the WHO\u2019s head of violence and injury prevention, told me. Road crashes are a major burden on the medical systems of these countries and exact staggering economic costs, amounting to about 5 percent of national GDP in Vietnam, for example.<\/p>\n<\/div>\n

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Meanwhile, as the total number of global road fatalities has stayed roughly constant for the last few decades, the gap between poor and rich countries has widened. Between 2010 and 2021, high-income countries, particularly those in Europe, saw dramatic decreases in car crash deaths, while deaths in the vast majority of low-income nations (which are predominantly in sub-Saharan Africa) increased, according to the WHO\u2019s most recent report on global road safety. Across lower-middle-income nations, like India, the aggregate number of deaths and the per capita fatality rate stayed roughly flat.<\/p>\n

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I asked Leather whether there was an easy, no-brainer intervention that could make a big dent in these deaths. He pointed, among other things, to helmets \u2014 in the Philippines, where he lives, national law now requires that helmets be made available with every new motorcycle purchase, though for that to work, people of course actually have to use them.<\/p>\n<\/div>\n

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\u201cIf you go to New Delhi today, nearly every motorcycle rider wears a certified full-faced helmet. This was achieved through strong enforcement,\u201d Kavi Bhalla, a professor at the University of Chicago\u2019s department of public health sciences and an expert on global road safety, told me in an email. \u201cIn contrast, most other cities in India don\u2019t enforce the helmet law, have very low helmet use, and this leads to many unnecessary deaths.\u201d<\/p>\n<\/div>\n

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Poor countries don\u2019t need to wait their turn for safer roads<\/strong><\/h2>\n<\/div>\n<\/div>\n
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Twenty years ago, two US economists published what became one of the most influential papers in the field of global road safety, on the relationship between a nation\u2019s wealth and its traffic fatality rate. As countries get richer, they argued, motor vehicle ownership rises, and per capita car deaths rise in tandem. Eventually, as countries become wealthier \u2014 and as safer roads, vehicles, and traffic policies catch up with motorization \u2014 fatality rates start to fall, as they did across much of the industrialized world beginning in the early 1970s. That tipping point, the authors found, comes at around $8,600 (in 1985 international dollars) of per capita GDP.<\/p>\n<\/div>\n

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But this \u201ceconomic determinism,\u201d as Bhalla has described it, might be the wrong way of looking at the problem. It contributes to a sense that traffic carnage is inevitable until a nation becomes rich. But we would never argue that maternal mortality or malaria deaths can\u2019t be significantly mitigated in low-income countries; in fact, we already know they have been. Although Europe, the US, and other high-income nations have steadily reduced car death rates over the last 60 years, Bhalla told me \u201cit is a mistake to think that this has much to do with these countries being rich.\u201d<\/p>\n<\/div>\n

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Instead, \u201csafety improved in these countries once they established national road safety agencies, gave them the authority to regulate what happens on the roads, and gave them a dedicated funding stream,\u201d he wrote to me. \u201cThese agencies did what you would expect agencies to do. They identified the most common traffic safety risks in the countries, undertook investigations on how best to address these, and then made investments for large scale interventions focused on safer designs of cars and roads, coordinated enforcement programs, and emergency medical systems. Low and middle income countries can and should do this now.\u201d<\/p>\n<\/div>\n

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The WHO and other global organizations, along with some philanthropies, have been working to speed along such work over the last few decades, but the results have so far been somewhat underwhelming. The United Nations had aimed to halve global road deaths from the baseline of roughly 1.2 million by 2020, a goal we didn\u2019t come anywhere close to reaching. On the other hand, world population has greatly increased in the last few decades, so holding the absolute number of traffic deaths constant is still a meaningful achievement: From 2010 to 2021, the global per capita<\/em> road fatality rate decreased by about 16 percent. And in that period, Tran said, road safety has at least gained a lot more visibility among political leaders and civil society as a badly neglected public health crisis.<\/p>\n<\/div>\n

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Having missed the 2020 target, the UN now aims to halve road deaths by 2030. But we will \u201cdefinitely not\u201d meet that goal either, Bhalla told me.<\/p>\n<\/div>\n

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A core reason the global road fatality crisis has been so maddeningly obstinate is that the root of the problem is complicated, contested, and depends on one\u2019s perspective. \u201cIt\u2019s not the same as when you\u2019re talking about Covid or HIV, where there is a virus\u201d that we want to eradicate, said Tran. \u201cWhen you talk about road safety, what is the virus?\u201d Is it dangerous individual behaviors \u2014 speeding, drunk driving, refusing to wear a seatbelt? Is it deteriorating roads or a lack of sidewalks? Is it humanity\u2019s growing dependence on cars themselves?<\/p>\n<\/div>\n

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Tran, like many road safety advocates today, calls for an approach that focuses on the most upstream cause of car fatalities \u2014 the proliferation of cars \u2014 and champions good urban planning designed to prioritize transit, walking, and cycling over the movement of cars. That would make safety an inherent feature of the transportation network and obviate the need for what Tran calls \u201cquick fixes\u201d to poorly designed systems.<\/p>\n<\/div>\n

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WHO director-general Tedros Adhanom Ghebreyesus echoed that message in the agency\u2019s 2023 road safety report: \u201cAs motor vehicles proliferate, countries are doubling down on transport systems built for cars, not people, and not with safety at their core,\u201d he wrote.<\/p>\n<\/div>\n

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There\u2019s a lot of wisdom to this, as the American experience over the last century well shows. The US experiment in car dependence has burdened us with a road fatality rate that rivals nations much poorer than us. Urban planners now widely agree that that car-dependent paradigm was a mistake, but now that it\u2019s built out, it\u2019s hard to claw our way out of.<\/p>\n<\/div>\n

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But that lesson also requires some humility: Even a car hater like me can acknowledge that for many people in poorer nations, automobility offers a measure of freedom that rich countries have taken for granted for many years. And it would be a mistake to see simple interventions that can save tens of thousands of lives, and that were instrumental in bringing down car fatalities in rich countries, as mere Band-Aids. We need both approaches. Just as humans did with once-devastating infectious diseases, we will have to learn to see a person killed for simply trying to get somewhere not as a tragic act of God, but as the result of forces within our control.<\/p>\n

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