Deaths and injuries from car accidents: an intractable problem?

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    2006 Elsevier Ltd. All rights reserved.

    5Keywords: Automobility; Culture; Traffic deaths and injuries; Emergent economies; Motorisation

    1. Introduction

    How sustainable is a product that results in the death orserious injury of millions of people who use the product orindeed millions more who merely happen to be in the proximitywhen something goes wrong? How can it be that the govern-ment of the United States of America is prepared to go towar over the deaths of a few thousand individuals in a terroristattack, when more than 40,000 per year are killed on the high-ways of that country? Why has this level of carnage beenaccepted despite many powerful protests [1,2]? Road deathsare the leading cause of mortality in adolescents and youngadults worldwide [3]. In total, since motorisation was startedthere have been more than 30 million deaths attributable toaccidents, more than all the soldiers in the 1914e1918 and1939e1945 world wars were combined.

    Inevitably, there are many complex social, cultural, po-

    incidents dispersed over many locations, does not generallymake for media headlines. Research into drivers attitudessuggests that the positive attributes of motoring are thoughtto be unequivocal and evident, while the negative attributesare seen as contested [4].

    This has led to the position whereby an individual sees his/her use of the car as necessary even when agreeing that in gen-eral cars should be used less. In addition, vehicle manufacturersand their suppliers can point to multiple design changes, newequipment, and new materials that have collectively resultedin cars that are safer in one way or another. Indeed, any con-sidered investigation into this topic would rapidly conclude thatvehicle design and performance are only two contributory fac-tors. As this paper demonstrates, there are many non-vehiclefactors to consider.

    It should not be forgotten that the original rationale for theregulation of exhaust emissions from vehicles was that thoseDeaths and injuries from car acc

    Peter W

    Centre for Automotive Industry Research, Cardiff Busin

    Colum Drive, Cardiff CF1

    Accepted 28

    Available online 14


    This paper presents an analysis of the implications of motorisation inIt is shown that emerging economies have high rates of death and injuincrease, so too could be the rate of deaths and injuries. Taking a broad vimedical services, and populist views of motoring, it is argued that redumore sustainable) cannot be achieved only by technical fixes to the carand resonant with distinct cultures of automobility, represent the most l

    Journal of Cleaner Production 1litical and economic forces at play here. The diffuse natureof automobile-related deaths and injuries, with many small

    * Tel.: 44 2920 87 40 00; fax: 44 2920 84 44 19.E-mail address:

    0959-6526/$ - see front matter 2006 Elsevier Ltd. All rights reserved.doi:10.1016/j.jclepro.2006.05.027idents: an intractable problem?


    ss School, Cardiff University, Aberconway Building,

    3EU, United Kingdom

    ay 2006

    September 2006

    merging economies for deaths and injuries from road traffic accidents.y alongside low vehicle ownership rates. If vehicle ownership ratesw of automobility culture to include cars, infrastructure, legal systems,ing the human cost of motorisation (and making motorised mobilityRather, approaches that are sensitised to the particularities of place,ely means to achieve more sustainable mobility.

    (2007) are toxic to humans. Thus, in causing air pollution(notably in urban areas) vehicles are a major cause of prema-ture death to the impacted human populations. The first auto-motive emissions legislation dates back to the early 1960s inCalifornia [5]. In other words, if our concerns are with sustain-ability, they are with the sustainability of human health and

  • the difference between life and death. Major improvements

    Phappiness. In this respect, vehicle safety is a critical issueparticularly now that progress with the control of exhaustemissions has reached levels of performance dramatically bet-ter than hitherto. Concerns with vehicle safety also go backa long way (remember the furore caused by Nader [6] in hisreport on vehicle design entitled Unsafe at any speed), andthere has been a gradual evolution of vehicle design in orderto achieve greater levels of safety performance. The initialfocus was, and to a large extent remains, that of the safetyof the vehicle occupants. More recently those concerns haveextended beyond the vehicle occupants to other road users.

    Crucially, however, the established motorised economieshave had many years to adjust to the growth in automobileownership and use, and in doing so have developed distinctcultures of automobility that have a critical bearing on therate of deaths and injuries from vehicle accidents. The firstsection of this paper therefore, outlines many factors thatcome to define the culture and practice of automobility andsafety as it emerges in different countries and at differenttimes. The second section describes the death and injury re-cords in countries with a long history of motorisation, andthose that are, in many respects, just embracing mass motor-isation. The final section analyses the intractability of the issuein those countries with emergent motorisation, but also arguesthat the concept of automobility culture is a useful means tounderstand the multi-faceted character of the problem andthereby, to enable a cohesive approach to be articulated.

    2. Automobility cultures and safety

    Table 1 provides a summary of the main factors pertainingto vehicle safety. The broad definition of automobility culturesadopted in this paper, includes institutional forces such as le-gal frameworks, regulation, and related matters along with thecustoms and habits of automotive practice: that is, how peoplebuy and use cars, and the often-iconic role played by carswithin popular culture [7]. This is a broader concept thanthe focus on the driverecar combination adopted by some so-ciological analyses of automobility, and supports the view thatsocial institutions act to embed the habits of drivers (in theircars) within the social fabric [8]. Inevitably, therefore, car cul-tures play across national identities, and are distinct betweensuch identities [9]. Thus, it is recognised that between andwithin cultures, cars themselves have symbolic meaning andcontent, and that this in itself can be critical to safety perfor-mance [10].

    The perspective advanced here is that in this broad sense dif-ferent automotive cultures may give rise to different outcomesin terms of deaths and injuries from accidents, and that thesolutions appropriate or effective in one location may nottherefore be so effective elsewhere.

    It is widely acknowledged that the failure of a particularcomponent or system on a car is rarely the source of a fatalaccident, at least in those countries where the stock of carsin use is relatively new and the regime to enforce continued

    P. Wells / Journal of Cleanervehicle inspection and repair is relatively robust.Nonetheless, systematic vehicle recalls (often for safetyreasons) are a feature of some countries, notably the US andJapan. In some cases, such recalls can cover millions of vehi-cles produced over a long period of time; in others it is limitedto just a few variants of a model. Vehicle manufacturers havea clear responsibility here, and indeed it was the failure tolive up to this requirement that caused the near-collapse of Mit-subishi Motors following an internal cover-up of the need to re-call vehicles due to a faulty wheel fixture [11]. Vehicle designhas advanced greatly over the years, offering both passive pro-tection (seatbelts, crumple zones, side-impact bars, etc.) andactive protection. The latter remains an important area for de-velopment with, for example, systems that use satellite map in-formation to adjust headlight direction towards approachingcorners, or radar-based guidance and avoidance systems. Thereis a school of thought that advocates the theory of risk com-pensation whereby drivers go faster and take more risks be-cause they have the (perceived) security features such asseatbelts, air bags and so forth. If it exists, it is likely to be ofminimal difference in terms of outcomes. Another school ofthought contends that car culture as practiced in countrieslike the UK and USA must change by abandoning the prevalentindividualism and embracing a willingness to cede control toexternal infrastructure managers if enhanced safety is to beachieved [12]. Such a view may have some resonance in coun-tries with a sufficiently developed traffic and information man-agement system, but would appear to offer scant benefits tocountries with emergent motorisation underway.

    Cultures of automobility are difficult to be precise about, butare still important at least as far as anecdotal evidence is con-cerned. One of the reasons why vehicle manufacturers sellingin the US market developed air bag technology (a hard rubberbag is inflated in front or to the side of the occupant duringa collision) was that it was difficult to get US car users towear seatbelts. US liability laws made vehicle manufacturersseek to provide systems that did not require user compliance,even though in some important respects the air bags repre-sented a hazard in themselves. In Europe, the introduction byBMW of the C1 motorbike caused a regulatory problembecause in some countries it was classed as a motorbike (andhence riders needed to wear a helmet) whereas, in others itwas classed as a two-wheeled car (and hence no helmet was re-quired). Any observer of European cities knows that as a rule,pedestrians in Germany will faithfully cross roads only at pre-scribed points, and only when the appropriate signal is given. Inother countries the use of proper pedestrian crossing points is atbest optional. In contrast, in Asia the practice of drivingmotorbikes without helmets, and with passengers riding side-saddle, strikes many observers as inviting disaster. Similarly,endemic overloading of vehicles with goods and passengersinevitably compromises the safety systems on the vehicle,and magnifies the scale of the accident when it happens.

    The value of the emergency services, and particularly med-ical services, is not always fully appreciated given that thetime taken to get proper medical treatment can literally be

    1117roduction 15 (2007) 1116e1121in the delivery of such emergency medical services have

  • Table 1

    Factors r


    Vehicle d ope with an accident, e.g. crush zones on front of car

    void an accident, e.g. ABS brakes and radar


    h that if they fail, they do so in a safe manner,

    ot off

    Vehicle m system, requires enforcement

    Physical iving conditions

    ct problems, e.g. mountain roads and Australian outback

    ct problems, e.g. Elk in Sweden

    Infrastru design, etc. all vital to road safety. Congestion may

    y by reducing average speed

    c. increase the risk of accidents

    Medical/ n order to save lives

    also important

    Vehicle r rol of private and public (e.g. taxi)

    ndards are maintained

    rivers are able to drive and do so responsibly. Rapid

    t in a nation of learner drivers

    police, garage regulation, etc., vital for retention of standards

    lps pay for medical treatment, legal process, and vehicle repair

    a minimum standard for sale

    be rectified in vehicles already in use

    Cultural safety priorities, e.g. drivers vs. pedestrians

    lcohol in the blood while driving; other drugs

    iving rules is a major cause or road accidents

    eath and injury among young people in the UK, not in Japan

    national stereotypes may exist and have an impact on safety

    Economi the ability to do anything positive with

    ms in this table







    1116e1121elating to automobility cultures and safety

    Item Comments

    esign Passive safety Features designed to c

    Active safety Features designed to a

    collision avoidance sy

    Failure mode Features designed suc

    e.g. brakes lock on, n

    aintenance Regular

    inspection regime

    Part of vehicle licence

    environment Climate Strongly influences dr

    Topography Can give rise to distin

    Fauna and flora Can give rise to distin

    cture Design Road layouts, junction

    actually improve safet

    Maintenance Poor road surfaces, et

    emergency system Emergency services Rapid response vital i

    General services Post-accident recovery

    egulatory system Vehicle licence system Important for the cont

    cars and to ensure sta

    Driver licence system Important to ensure d

    motorisation can resul

    Wider system Lack of corruption in

    Insurance An efficient system he

    Type approval Ensures vehicles meet

    Vehicle recall system Ensures problems can

    attitudes Attitudes to life, death

    and individualism

    Has consequences for

    Drug use Permissible levels of a

    Rule compliance Non-observance of dr

    Car crime Significant cause of d

    Driving styles Vary widely but some

    c conditions Income, cost of motoring, etc. Significant impact on

    respect to the other ite

  • been an important contributory factor in reducing death andinjury rates in many countries [13]. By contrast, in Ghanaonly 27% of people injured in road traffic accidents subse-quently had access to medical services [14].

    Strangely, the importance of roads in popular culture hasbeen rather neglected [15], as has the contribution of road de-sign to safety. It is only in the recent past that in Europe thelong-standing vehicle safety testing programme (EuroNCAP)has been joined by a scheme to identify roads with a highincidence of traffic accidents [16].

    The relative level of economic development is undoubtedlya factor here. Prosperity makes it possible to afford newer(safer) cars and items such as maintenance and insurance atthe individual level. At the social level, prosperity means roadscan be built and kept in good order, an honest and efficient po-lice force can be recruited, and rules can be enforced. Povertyforces people to take risks, with inevitable consequences.

    3. Deaths and injuries from road accidents: the recordin established and emerging motorised economies

    It is also clear that over time safety performance has gener-ally improved despite growth in the number of cars in circula-tion, or indeed the average annual distance travelled. Forsome, this is a correlation with the stage of economic develop-ment: beyond a certain threshold level, the rate of accidentsdeclines with growth in per capita income. In the UK, for ex-ample, fatalities due to road accidents in 1960 were 6970; in2003 they numbered 3658 despite an enormous growth inroad traffic during the intervening period. Despite this im-provement, however, the level of deaths and injuries, even incountries with prolonged experience of mass motorisation, isunacceptable to a great many within those societies. Not least,this may be because so many of those deaths and injuries areoccurring to those outside the vehicle. A particular feature ofthis debate in recent years in the US and increasingly in theUK has been the growth in ownership of large, ostensiblyoff-road, vehicles for reasons of personal safety or other per-sonal interests. In brief, this has become a divisive issue in ur-ban areas, with the drivers of these large vehicles being seen asselfishly pursuing their own interests over and above those (of-ten less fortunate people) around them [17]. All the evidencesuggests that these large vehicles do inflict disproportionatedamage on smaller vehicles and their occupants [18,19].

    Therefore, a theme emerges with respect to deaths and in-juries within the established motorised countries: that there aredistinct sub-populations with a higher likelihood of involve-ment in an accident and that policy is increasingly directedat these sub-populations rather in the more general population.Table 2 shows for the UK a breakdown of deaths and injuriesfor the major classes of road user, where it can be seen thatmany are effectively victims of motorisation rather thanparticipants.

    In some respects then, deaths and injuries from vehicleaccidents reinforce or underline existing social inequalities.

    P. Wells / Journal of Cleaner PIt is the poor, the old, or the young who tend to be affectedin a disproportionate manner.It is interesting also to make comparisons between coun-tries, for this helps to reveal some substantial differencesthat do not necessarily correlate simply with the average ofgross domestic product per head. Table 3 provides compari-sons of selected countries.

    It is evident from Table 3 that the UK has a comparativelylow rate of deaths per 100,000 people due to road accidents. Incontrast, the USA has a rate of deaths per 100,000 that is morethan double that of the UK and of a similar rate to Poland,which of course has a much lower level of economic develop-ment. In the case of the USA, deaths per 100 million mileshave fallen from 1.73 (in 1994) to 1.48 (in 2003) accordingto the National Highway Traffic Safety Administration. Again,much depends upon how the figures are calculated and pre-sented. Similar comments apply, with even more force, tothe question of how the economic impact of such deaths andinjuries is calculated.

    The key concern, however, is with those countries that arerelatively newly motorising, and yet also have a high rate ofaccidents resulting in deaths and injuries. Table 4 uses twosources to illustrate both the death rate per 100,000 people,and the rate of car ownership per 1000 people to illustratethe problem.

    Some of the very highest death rates as measured in termsof the ratio against the population occur in South and CentralAmerica: in countries like El Salvador. What is more worryingis that China has a death rate almost four times that found inthe UK, but with a tiny fraction of the car ownership levels.Put another way, if car ownership levels in China reach thosein the UK and accident rates grew in line, then China wouldsuffer a death rate of 1349 per 100,000 or an annual deathrate of 13.5 million people.

    Table 2

    Deaths and injuries: the UK by category, 2004

    Category All accidents Fatal or


    Pedestrians 38,881 7478

    Cyclists 16,648 2308

    Motorcyclists 25,641 6648

    Cars 183,858 16,144

    Buses and coaches 8820 488

    Commercial vehicles 9049 1037

    All road users 280,840 34,351

    Source: SMMT [20], p. 197.

    Note: all road users category include modes not listed in the table separately.

    Table 3

    Road deaths in 2003, absolute number per 100,000 of the population, selected


    Country Road deaths Deaths per

    100,000 people

    UK 3658 6.1

    Norway 23 7.9

    Germany 6613 8.0

    France 6058 10.2

    Poland 5640 14.8

    USA 42,643 14.7

    1119roduction 15 (2007) 1116e1121Source: SMMT [20] 2005, p. 197.

  • rMoreover, it is evident from the example of Kuwait that highlevels of car ownership are not a guarantee of reduced deathrates. Figures for India were not available from either of thedata sources used here, and the robustness of much of the datathat are available is somewhat open to question. If anything,the real picture in many countries is much worse than the offi-cial data suggest, with many injuries not reported to police ormedical authorities. It is for these reasons that theWorld HealthOrganisation has drawn attention to the human cost of motorisa-tion [21]. In this analysis the concept of Disability Adjusted LifeYears (DALYs) lost was used to capture the way in which acci-dents (the WHO prefers the term incidents, because accidentssuggest an event that was not possible to prevent) deprive peo-ple of fully functional lives even when they are not actuallykilled. In the analysis, traffic injuries were expected to growfrom the ninth most important cause of DALYs lost in 1990,to the third most important by 2020. Only heart disease and ma-jor depression are expected to be more important.

    4. Emergent motorisation, safety and therole of automobility culture

    If automotive cultures have been relatively (and surpris-ingly) neglected in those countries in which motorisation is al-ready deeply embedded, then even less attention has beengiven to those cultures as they apply in countries with emer-gent motorisation. Interestingly, one of the leading sociologi-cal theorists identifies six dimensions to the culture ofautomobility [7]. These are as follows:

    The car as the quintessential manufactured object; The car as the major item of household consumption; The car as the fulcrum of an extremely powerful and di-verse complex involving fuel supply, industrial supplychains, etc.;

    The car as the dominant form of quasi-private mobility; The car as the definition of the dominant culture in termsof representing the good life, and in terms of being theresonant artefact in many cultural media forms includingcinema, books, etc.; and

    Table 4

    Death rates and car ownership rates in selected countries

    Country Death rate

    per 100,000 people

    (1998e2003 average)

    Car ownership

    per 1000

    people (2004)

    China 19.0 7

    Columbia 24.2 36

    Dominican Republic 41.1 44

    El Salvador 41.7 20

    Peru 17.6 30

    Nicaragua 20.1 13

    Kuwait 23.7 432

    USA 14.7 459

    UK 6.1 499

    Sources: Death rate data from World Bank [21]; car ownership data from

    SMMT [20].

    1120 P. Wells / Journal of Cleaner P The car as the most important cause of environmental re-source use.It is only in the latter category that the air quality andmedical implications of car use get a mention. It is perhapsillustrative that even professional experts on culture can besomewhat blind to the human costs of automobility.

    In emergent economies, the route to mass motorisation is of-ten somewhat different to that was adopted in the industrialisedeconomies, and the characteristics of the vehicles in use mayalso be different. Hence, in emergent economies, motorisationmay have been started with trucks and buses, with motorbikesand/or rickshaws thereafter, followed by taxis and state or com-pany cars and with private passenger cars as a late (and minor-ity) choice. Is the auto rickshaw a sign of backwardness or of anappropriate solution to the need for mobility? These vehiclesoffer scant protection for the drivers and occupants, but arelight, nimble, fuel efficient and cheap. In the wider context ofthe culture of automobility even casual observation would sug-gest that there are significant and enduring differences acrossemergent economies. In addition, it is evident that the waysin which vehicles are used, the entire roadside experience, isradically different between the UK and India [9].

    So, if automobility cultures are different, and lead to differ-ent outcomes in terms of deaths and injuries, do they also resultin different prospects for the further development of improvedsafety in automobility? Moreover, do those different automo-bility cultures interact with wider issues of social cohesion?

    In some respects, the poor in emergent economies havealready made sacrifices to accommodate the car, and willprobably continue to do so. In China, for example, the majorcity such as Beijing has been bulldozing the houses of the urbanpoor to make way for new roads, while at the same time ex-cluding bicycles.

    In India it is the burgeoning middle class that can affordmotorisation but, with the majority of deaths outside the vehi-cle, it is the poor who predominantly pay the price. As an il-lustration, in the USA over 60% of those killed in road trafficaccidents are drivers of vehicles; in Kenya less than 10% ofthose killed are drivers [14]. That is, those who enjoy the ben-efits of mobility tend to do so at the expense of those who arealready excluded from these benefits. If this issue is then over-laid on that of caste divisions it can be readily appreciated thatenduring social structures in India are emphasised by this pat-tern of outcomes: with uncertain social consequences.

    So, in the first instance there may be self-limiting features tothe culture of automobility in emergent economies that makesfurther motorisation difficult. These may be institutional, infra-structural, legal, technical, or indeed simply down to problemsof social adaptation: China would have to become a nation oflearner-drivers! Rather than simply working to remove suchimpediments to further motorisation, it might be more prudentto retain them unless and until other aspects of automobilityculture are put in place. Second, an understanding of automo-bility culture may enable priorities to be assessed and a trajec-tory for motorisation to be determined in a manner that is moresustainable than the simple replication of the experience of thealready-motorised economies. This in turn suggests that there

    oduction 15 (2007) 1116e1121is an inherent tension between the forces of globalisation thathas propelled the automotive industry and its apparently

  • ubiquitous products into markets around the world, and thoseof locality that remain both distinct and enduring.

    All of which suggest that the problem of deaths and in-juries due to traffic accidents in emergent economies is nota single problem at all [22]. It is, in fact, not susceptible toa simple, single solution like an inoculation programme. Ineach case, the measures deployed must rest on an understand-ing of the specific characteristics of automobility culture asthey are manifested in each country. In each case also, it isclear that the issues of mobility-related human costs are insep-arable from the social context within which they occur. Thismeans that automobility, as a social process, could be farmore disruptive than perhaps is usually imagined, and in coun-tries like China where centralised control is still preferred it isdifficult to see how such social processes can be reconciledwith the prevailing regime.

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    1121P. Wells / Journal of Cleaner Production 15 (2007) 1116e11215. Conclusions

    This paper has presented a review of the issue of traffic-related deaths and injuries, but with a focus on automobilitycultures as a key explanatory variable. In a very literal sense,the motorisation of emergent economies is an accident waitingto happen, and one not reducible to technical fixes in the vehi-cle or in infrastructures. If the automotive industry is to bemore sustainable, it must be a contributory element to resolvethe dilemma of motorised mobility in emergent economies.

    It is evident that automobility cultures are complex, diverseand shifting. Yet an understanding of these cultures seems tobe essential to finding answers to the problems of motorisa-tion. There is a very real danger that if answers are not found,then it is the victims of motorisation who will rise up and findsolutions for themselves, with possibly catastrophic results.


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    [17] Wells P. Off-road cars: on-road menace. London: Greenpeace; 2006.

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    Crandall J. Pedestrian crashes: higher injury severity and mortality rate

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    Deaths and injuries from car accidents: an intractable problem?IntroductionAutomobility cultures and safetyDeaths and injuries from road accidents: the record in established and emerging motorised economiesEmergent motorisation, safety and the role of automobility cultureConclusionsReferences


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