Reviews PERSONAL VIEWS

Death on the road to international development

BMJ 2005; 330 doi: http://dx.doi.org/10.1136/bmj.330.7497.972 (Published 21 April 2005) Cite this as: BMJ 2005;330:972
  1. Ian Roberts, professor of epidemiology and population health (Ian.Roberts{at}lshtm.ac.uk)
  1. London School of Hygiene and Tropical Medicine

    We don't know much about her. All we know is that in 2003 a small Tanzanian girl died after having been run over by a truck, a truck belonging to a company managed by CDC (formerly the Commonwealth Development Corporation, and now wholly owned by the Department for International Development of the UK government). According to CDC records the girl did not die at the scene, but “following poor care she died in the hospital 3dayslater.”

    CDC's mission is to create wealth in emerging markets, particularly poorer countries, by investing in “sustainable” private sector businesses. In 2003 CDC made a pretax profit of £45m ($85m; €65m), some £15.6m of which was made from its investment in Africa.

    Last year I gave a lunchtime seminar on road safety to CDC managers. Before the seminar I was given a summary of the fatal “accidents” attributable to CDC managed businesses in 2003. The Tanzanian girl was not the only child to have died on the road to international development in 2003. The same year a two year old Tanzanian child was crushed to death by a tractor, and in Swaziland, a contractor's truck struck and killed a child on his way to school.

    CDC records show that there were 13 fatal injuries “directly attributable to the work activities of the CDC group,” about half of which were traffic related injuries. But these are just the deaths that we know about. Road deaths are notoriously under-reported in low and middle income countries. Studies have found that the actual numbers of road deaths can be four times as high as the figures shown in police statistics, and the number of serious injuries is almost 75 times higher. Moreover, death is just the tip of the injury iceberg. For each death there are about 15 injuries requiring hospitalisation and 70 minor injuries.



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    Who pays the human cost of transport in the developing world?

    Credit: WHO

    According to Richard Laing, chief executive of CDC, only fatal injuries are reported to head office in London. Nevertheless, none of the deaths were mentioned in the 2003 annual report. All the report says is that CDC requires the companies in which it invests to observe “minimum standards in relation to health, safety and social issues.” For some children these minimum standards were not enough.

    It is immoral for the Department for International Development to continue to pay insufficient heed to the human cost of transport

    Captains of industry are excited about international trade because of its potential to increase profits. It is more profitable to run businesses in poor countries, where wages are low, than in rich countries, where workers enjoy decent wages and reasonable standards of health and safety. All that is required is cheap transport—which means adequate roads, preferably paid for by the public, cheap fuel, and victims who pay the human cost of road death and injury. If businesses had to pay the full social and environmental costs of transport then trade would be much less efficient and they would show little enthusiasm for it. Fortunately for business, ordinary people pay much of the costs, so that business in Africa is lucrative. For CDC this means a “positive fund performance” of around 20%. But what has all this got to do with international development? According to the World Health Organisation the economic losses associated with traffic injuries in developing countries is close to 2% of their combined gross domestic product, nearly $100bn, twice as much as all overseas development assistance. Every year in Africa 200 000 people are killed on the roads and millions seriously injured. These losses only serve to inhibit development and perpetuate poverty.

    So what is the Department for International Development doing about all this? According to the secretary of state for international development, the department's response to the global road safety crisis is to provide funding for the Global Road Safety Partnership. This partnership, the brain child of the World Bank, brings together over 70 private sector and governmental organisations to improve road safety around the world. The partnership includes corporate giants such as the car makers Ford, DaimlerChrysler, and Volvo, and the drinks multinationals Bacardi-Martini and United Distillers. Are these the socially responsible, philanthropic organisations that will bring road safety to Africa, or has the department put the fox in charge of the chickens?

    According to Joseph Stiglitz, former chief economist at the World Bank, globalisation has been brought about “by the enormous reduction of costs of transportation and communication.” But have the costs of transportation really fallen or have they merely been externalised? The human cost of transport is not paid by global business but by Africans. And the cost is staggering. A recent report by the World Health Organization and World Bank shows that the WHO African region had the highest road traffic death rate in 2002, estimated at 28.3 per 100 000 population (World Report on Road Traffic Injury Prevention. Geneva: World Health Organization, 2004) and it is projected that the number of road traffic fatalities in sub-Saharan Africa will increase by 80% between 2000 and 2020. Creating wealth in poorer countries is a noble aim but it is immoral for the Department for International Development to continue to pay insufficient heed to the human cost of transport.