The health repercussions of Government transport policies

Abstract

A couple of hours into the late shift in Accident and Emergency (A & E) a boy is brought in, conscious but struggling for breath. He has been hit by a car, his lungs crushed by the wheels and his leg broken. Myriad images stay locked in my mind. A resuscitation room filled with people, the fraught, tense atmosphere. Anguished faces of parents, the primary survey and monitoring, oxygen, fluids and IV lines, running to fetch blood bags, chest drains. Then catheterisation, secondary survey, and all the time frightened eyes: ‘Mummy I don’t want to die. I’m getting so tired...’ The boy died in Intensive Care early the next morning following surgery to try to salvage his lungs. The best efforts of the A & E, Orthopaedic, Thoracic, Paediatric and ITU teams working through the night had not been enough to save his life. The damage had been too severe. He was 9 years old. It is now a number of months since that afternoon, but its impact stays with me. It has thrown into focus many issues surrounding road safety, particularly those of accident prevention, leading inevitably to fundamental questions concerning priorities and philosophies in current transport policy and the way they structure people’s lives with inescapable consequences for their health. Road traffic accidents are the largest single cause of accidental death. The statistics show that more than 5000 people are killed by road vehicles each year in the UK with many more injured, often seriously (Department of Transport 1991). While this number is in itself shocking, it is the vulnerability of pedestrian children, with those from social classes IV and V at the highest risk, which is particularly unacceptable. Road traffic accidents account for a quarter of all deaths of schoolchildren and two thirds of all accidental deaths (Department of Transport 1991). It is striking that pedestrians and cyclists together account for 1 in 3 of all fatal and serious road injuries, although they account only for about 1 in 14 of all road users (Quick 1991). While total road traflic accident rates (including pedestrian) have remained fairly constant for 60 years, pedestrian activity has in fact markedly declined over the past decade, indicating a proportional rise in pedestrian victims (Hillman et al 1990). Children obviously make up a substantial portion of the pedestrian population and are therefore inevitably at greater risk. But inequalities in the health damaging effects of road transport are not limited to age alone. Mortality ratios for road traffic accidents involving children aged 1-15 show steep social class gradients, with the ratio increasing dramatically from social class I to V for most types of road user, and particularly for pedestrians. Children in Social Class V are nearly 3 times as likely to be involved in a fatal accident than those in Class I; and well over 4 times as likely to be involved in a fatal accident if pedestrian (Preston 1992). Why have roads become so much more dangerous for children? The obvious answer is that there has been a significant increase in the number of cars. However, this is only part of the problem. Government transport policy has been to build more, bigger and faster roads at the expense of subsidised public transport which studies have shown as a relatively safer form of transport (Department of Transport 1990; Public Health Alliance 1991). The introduction of compulsory safety belts, child car restraints, and the progressive incorporation of new safety features like cages and impact balloons has significantly improved the lot of the car user. As driving becomes ever more desirable and safer, so remaining a pedestrian becomes yet more and more hazardous. People in the lower income brackets, who cannot afford access to a car and who cannot therefore ferry their children to and from school and social functions, are most at risk. Only 2% of children from families headed by an unskilled worker will be driven to school, in contrast to 36% of those in families headed by professionals (Birmingham Public Health Alliance, 1991). Whether living in urban or rural areas, it is the poorer classes that are always hit the hardest. In the inner city, the place where children in the lower classes frequently live, traffic is denser, there are fewer safe places to play, and pedestrian casualties are higher -7 times greater in most urban counties than in rural ones according to Birmingham PHA (1991). On the other hand,