Tackling a neglected mass killer: road deaths
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Founded in 1498 as the first European colonial city in the New World, Santo Domingo — capital of the Dominican Republic — became a staging post for the Spanish conquest of Latin America. Today, however, Santo Domingo stands out internationally in an altogether different way. Deaths and injuries on the city’s roads are tragically frequent, and the reason the country ranks fifth for road deaths worldwide.
Road deaths in Santo Domingo accounted for many of the 2,967 recorded across the whole country in 2021 — the second highest level in the Caribbean and Latin America, according to city mayor Carolina Mejía. And the 20-24 age group was the worst affected, with 480 road deaths nationwide in 2021.
“Our statistics are very sad,” says the mayor. “We see thousands of accidents every day.”
Unsafe roads are a neglected killer, globally, causing 1.3mn deaths in total every year and leaving 20mn to 50mn people seriously injured. Road deaths now outrank those from HIV/AIDs, tuberculosis and diarrhoeal illness and disproportionately affect the young: traffic collisions are the leading cause of death for children and young adults aged five to 29.
Unicef, the UN’s children’s fund, calculates that there are more than 600 road deaths among young people globally every day: a potentially preventable death every two minutes.
“It is really a leading killer that doesn’t get the attention it deserves”, says Kelly Larson, leader of the Bloomberg Philanthropies Initiative for Road Safety and head of the Partnership for Healthy Cities programme. The latter was the co-host, with the World Health Organization, of the first Partnership for Healthy Cities Summit, held in London in March this year.
More than half of traffic deaths occur in cities — showing the need, and the opportunity, to build safer environments for younger citizens. “We see [cities] as critical to influencing national legislation and demonstrating what can be done to really save lives,” Larson says.
The UN’s Decade of Action for Road Safety, launched in 2020, aims to halve road traffic deaths and injuries by 2030 — a change also targeted by Mejía’s administration in Santo Domingo, in line with the UN’s Sustainable Development Goals.
Previous efforts failed to target interventions effectively and focused more on behavioural factors, such as drink-driving, at the expense of “at source” infrastructural changes that build safety into road layouts.
Cities in low- and middle-income countries (LMICs) face the greatest challenges. These countries have 60 per cent of the world’s vehicles but account for 93 per cent of all road fatalities, according to the WHO. People are three times more likely to die on the road in a low-income country than in a high-income one. The risks posed to children are also heightened: 97 per cent of child road traffic injuries occur in LMICs.
One effect of economic development in LMICs is an increase in registered vehicles. In 2003, there were approximately 2.2mn on Dominican roads; by 2015 that had risen to 3.6mn. But time lags on legislation and infrastructure investment mean road networks and existing safety measures in LMICs fail to keep pace. Economic efficiency — and the ability to travel quickly by car — is prioritised above wider safety and ease of movement by foot or bicycle.
It is mainly “vulnerable” travellers — such as pedestrians, cyclists and motorcyclists — that suffer. They account for more than half of all global road traffic deaths.
In Santo Domingo, however, policymakers are seeking to reclaim the initiative — targeting, in particular, the speeding that is behind more than half of road deaths.
Mayor Mejía has introduced a 35kph speed limit on the Malecón, a busy 10km coastal road, which studies suggest can reduce fatal injuries to child pedestrians by 70 per cent. A traffic diversion scheme has also cut the number of heavy goods vehicles using this stretch by about half. Speed limit reductions from 60kph to 50kph are planned citywide.
Other youth-focused strategies include safe routes across Santo Domingo’s 126 parks and green spaces, cycle paths, and play areas away from busy roads. Painted crossings on five dangerous intersections help those with disabilities, particularly autism and Down’s syndrome.
The programme, featuring a standardised “stop, look, stop, cross” infographic, is a collaboration between the schools of special education and architecture at the Universidad Nacional Pedro Henríquez Ureña and the wider community. It is a small, yet powerful, way to reclaim road space and prioritise other forms of travel.
Each painting session — in which local communities took part — was “like a party . . . it brought the people together”, says Laura Pérez, co-ordinator of the university’s special education department. Her students are also involved in the development of a road safety course soon to be rolled out across the city’s schools.
Larson says the existence of a global library of evidence-based road safety interventions has been a major help. But, while “knowing what works” is important, the challenge is to drive change through implementation where it is most needed. Local political will is vital.
“What we’re trying to do . . . is to find all those small action items that we can start on right away”, Mejía says. “With all the difficulties we have, we cannot afford to wait until we have everything worked out.”
Road collisions are also serious economic burdens: crashes cost countries about 3 per cent of GDP, according to the World Bank. When cities that are significant growth hubs fail to tackle what is a resource-draining public health problem, a country’s development potential is limited.
For these reasons, road safety must be “framed as a problem for development”, says Nhan Tran, head of safety and mobility at the WHO.
De-prioritising motor vehiclesis one important way to limit fatalities and injuries at source — especially for children and young people. Safety interventions can have positive effects on emissions, urban health and aspects of economic growth, too.
Making roads less lethal is a challenge that cities such as Santo Domingo are at last taking steps to tackle.