health social justice transport

The overlooked problem of road safety

Last week I mentioned the Millennium Development Goals, reviewing progress as they reach the end of their run. Discussions about what goals we should implement in their place are ongoing, but here’s a more leftfield suggestion: road safety.

With 1.24 million people killed every year, death by road accident comes 8th in the world’s top ten causes of death. As the number of cars in the world grows, it is expected to rise to 5th by 2030. Investing now will save millions of lives over the coming decade, and spare millions more from injury and disability.


Those lives saved will be mainly young people, who are disproportionately affected. Road accidents are already the leading cause of death for those aged 15-29. They will mostly be in poorer parts of the world, as 80% of road accidents are in developing countries. And half of those affected will not be in cars at the time. They will be walking, cycling. A quarter of those killed by cars in developing countries are pedestrians.

This makes road safety a justice issue – the people killed or maimed by cars are often those who can’t drive themselves, either because they’re not old enough, or because they can’t afford a car. Growing up in Madagascar, it was only the richest who could drive. If you could afford a car, you could also afford to bribe your way out of any accidents you caused. And of course the poorest may not have access to medical care either. Corruption and unsafe roads are a tragic combination, and I’ve personally witnessed the results on a couple of occasions.

Because it is the richest who drive and they can command more lobbying power, road improvements for car users tend to come first when budgets are tight. Measures for pedestrians are much lower on the agenda. To give an example, one of major roads out of Nairobi that I used to travel regularly was widened in the 90s and turned into a highway. But it cut straight through several major settlements, and there weren’t nearly enough pedestrian bridges. Nobody was going to walk half a mile out of their way to cross the road, so they just ran across. When this emerged as a problem, the authorities built a wall down the middle to stop people doing it, as this was presumably cheaper than bridges. But that just made it worse, because young men would run and vault over the wall.

Pedestrian road users are more vulnerable and often more numerous, so barriers and crossings shouldn’t be seen as an optional extra. Pavements are particularly important. Without them, there is nothing to distinguish between space for people and space for cars. It’s hard to establish who is at fault, and even easier to dodge responsibility for accidents.

This is a major challenge for the developing world, especially for middle income countries. The number of cars has risen steeply, with traffic increasing faster than road infrastructure can be built or police and emergency service capacity added. However, the World Health Organisation reports that 88 countries have reduced the number of road accidents in the last few years. Among that 88 are 41 middle-income and five low-income countries, so it is not inevitable. Safety can be improved, and it doesn’t need to be a luxury.

One of the good reasons to act on road safety is that we know what works. There’s no new technology to invent or cure to find. Building pavements is one of the most important. Introducing and then policing speed limits. Requiring helmets for motorcyclists and seat-belts for cars would be a major life saver. Only two-thirds of the world’s countries have robust laws on drink-driving. There is no shortage of case studies of countries or cities that have run successful campaigns to update the law, train police, and educate citizens. Roads can be safer. Lives can be saved.

One of the central ideas of the effective altruism movement is that if you want to see your money go a long way, seek out overlooked problems. Under that logic, road safety could well be a key intervention over the coming decade. As Simon Kuper wrote in the Financial Times recently, “if humanity wants some quick wins, a good place to start would be road accidents.”


  1. Great blog this one as I have always believed the most dangerous thing about working in Africa and developing countries around the world isn’t disease, conflict, etc but traffic. I’ve had more aid friends injured and killed in traffic accidents than any other reason…

    1. Yes, definitely a big risk, and I’ve had a couple of near misses myself. I’ve seen people hit by cars on four different occasions that I can remember, and all of them were in Africa.

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