High-income is not necessarily associated with better road safety performance in the Eastern Mediterranean Region

There is an interesting relationship between national income and road safety that becomes apparent when going through the second global status report on road safety (GSRRS). Numerous studies have shown that the wealth of a country is one of the major determinants of road fatality risk. One study by Koptis and Cropper (2005) showed that, with increasing gross national income (GNI) per capita, the road fatality rate initially increases but after reaching a certain level it would decline. Road fatality rate reaches its lowest level when the income of a country was “high” as per the World Bank criteria. Based on empirical data, it is hypothesized that economic growth initially leads to immediate increases in the vehicle ownership, which increases road exposure and consequently, road fatalities. Economic growth is also associated with investments in road safety, vehicle maintenance, traffic enforcement and emergency care facilitates and other measures that decrease road fatality risks. Koptis and Cropper estimated that the road fatality rate begins to decline when the GNI per capita is around 8,600 US$ (reference year 1985). This is consistent with the findings from Bishai et al. (2006) showing that road fatality rate could start to decline when the national gross domestic product reaches anywhere from US$1,500 to US$8,000 per capita (data from 41 countries).

The second GSRRS indicated that the road fatality risks in the Eastern Mediterranean Region (or EMR) were paradoxical. The road fatality rates in the high-income countries (HICs) of EMR (namely Bahrain, Kuwait, Oman, Qatar, Saudi Arabia, and United Arab Emirates) were much higher than the HICs in other regions as well as the low- and middle-income countries (LMICs) in the EMR region. The road fatalities per 100,000 people in the six HICs of the EMR was 21.7 compared with the 6.3 to 11.4 observed in HICs of the North America, Europe and Western Pacific. In addition, LMICs in the EMR had a road fatality rate of 21.4 per 100,000 people (Please see table 1 http://injuryprevention.bmj.com/content/19/2/150.short?g=w_injuryprevention_current_tab), which was lower than the rate observed for HICs in the EMR. The current GNI per capita of the EMR HICs ranged from US$ 15,920 (2010, Bahrain) to $73,060 (2010, Qatar), well above the cut-off proposed by Koptis and Cropper (2005) and Bishai et al (2006).

Editor: The high burden from road fatalities in HICs of the EMR is unexpected and unacceptable. The GSRRS pointed to the low compliance of road safety laws and their enforcement in the EMR HICs compared to HICs in other regions as possible reasons for the high road fatality rate. The EMR HICs should prioritize road safety interventions immediately as they have the resources to address this pressing public health issue.

 Acknowledgement: G. Tung.


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