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The shocking death toll of cars in poor countries

We’ve made little progress against one of the world’s greatest killers.

The story of global health over the last few centuries has generally been one of great progress — 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’s poor. It kills about as many people as the world’s deadliest infectious disease — tuberculosis — and it’s 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’s most dangerous gifts: the car.

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 — likely between 20 and 50 million — 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’s cars.

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 roughly the same for the last 20 years. As motor vehicles spread around the world — the total fleet has doubled over the past 20 years — the burden of those deaths has shifted increasingly to lower-income countries. Despite all the progress we’ve made against ancient natural killers, we’re making little against a killer we engineered ourselves.

That’s not for a lack of known solutions, but rather because there’s 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’s “one of the few public health problems where society and decision makers still accept death and disability on such a large scale as inevitable,” the late Dinesh Mohan of the Indian Institute of Technology wrote in 2019.

“You can become very depressed,” 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). “Why is no one taking this seriously?”

Of course, it’s 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.

Why cars kill so many people in countries with so few of them

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 highest road fatality........

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