Road deaths three times higher in poorer European countriesBMJ 2009; 339 doi: https://doi.org/10.1136/bmj.b4951 (Published 23 November 2009) Cite this as: BMJ 2009;339:b4951
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Wealth-related discrepancies regarding road mortality rates are
unsurprising. A number of issues could contribute, as is made clear in
Kmietowicz's synopsis. Fatalities have steadily reduced within many states
- including Britain - over many years (1): an overarching view might be
that a safety culture affecting attitudes, roads and vehicles takes time
and resources to develop.
However, the appeal to a safety culture has limits:
(a) The provision of appropriate medical services optimises the
survival of crash victims. An examination of casualties on British roads
and railways is instructive: rail has not entailed the kind of safety
interventions common on the road - such as seat-belts - yet rail speeds
have risen steadily. For both modes of transport, the ratio of deaths to
injuries has steadily reduced over the last fifty years or so: a
particular severity of incident is now much less likely to lead to death
than previously (2). However, trauma treatment as a means of reducing
mortality entails an expensive burden on health services.
(b) Burgeoning motorisation increases danger for pedestrians,
cyclists and other vulnerable road-users. Amerlioration in rich countries
has often entailed an implicit assumption that only a negligible portion
of the population will be too poor to remain non-drivers. However, the
expensive health problems resulting from the shift away from physical
activity have often gone unnoticed in road costings.
(c) Increased motorisation eventually entails such congestion that
traffic speed is seriously reduced: in countries where motoring is long-
established congestion now often extends well beyond the traditional "rush
-hours". Mortality for motorists is thereby reduced. Again, reducing
mortality by this means comes with untoward health costs, in this case due
However the issues raised by international differences in road deaths
are interpreted, we should be mindful of the heavy costs imposed on health
services - costs that only rich countries may be able to afford.
1. Department for Transport (2008). Transport statistics Great
Britain: 2007 annual report. London, England: TSO
2. Reinhardt-Rutland A H (2002). Has safety engineering worked?
Comparing mortality on road and rail. In P T McCabe (ed). Contemporary
ergonomics 2003. London, England: Taylor & Francis.
Competing interests: No competing interests