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Small-scale hazards: The case of road traffic accidents221resources for education, can drive families into poverty (seeBox 9.1). Such high economic impact at the household levelis explained by most road fatalities and injuries being amongyoung men, the most economically active social group inthese societies. In Kenya, for example, more than 75 percent of road traffic casualties are among economicallyproductive young adults. 18 The impact of accidents is likelyto be especially magnified in those societies where there islimited or no state support for medical treatment or socialsecurity for those who are unable to work as a result ofdisability following an accident. The psychological and financialburden of caring for a previously economically activefamily member who has been disabled through an accidentcan be even more destabilizing for the household economy.The second leading cause of orphaned children in Mexico isthe loss of parents as a result of road traffic accidents. 19VULNERABILITY ANDCAUSES OF ROAD TRAFFICACCIDENTSRoad traffic accidents result from a combination of structural,physical and behavioural factors (see Box 9.2). Whilethe exposure of road users to traffic accidents is shaped byphysical aspects of the road environment, individual behaviour,awareness of safety regulations and travel habits alsodetermine vulnerability to traffic accident risks. In addition,the safety and design features of vehicles shape the likelihoodof being involved in a traffic accident, as well as theseverity of the impact.World region Regional GNP Estimated annual accident costsGNP (percentage) Cost (US$ billion)Africa 370 1.0 3.7Asia 2454 1.0 24.5Latin America and the Caribbean 1890 1.0 18.9Middle East 495 1.5 7.4Central and Eastern Europe 659 1.5 9.9Highly motorized countries 22,665 2.0 453.0Total 517.8Vulnerability to injury and death from trafficaccidents also varies according to the mode of transportationused. In societies with high levels of motorization, vehicleusers are most vulnerable to accidents (see Figure 9.1). Inmiddle- and low-income countries, vulnerability is highestfor unprotected road users – pedestrians, cyclists and motorcyclists.For instance, causalities are highest amongtwo-wheel vehicle users in Thailand, Indonesia and Malaysia(see Figure 9.1). This is not surprising given the dominanceof two- and three-wheeled vehicles in the region, accountingfor well over 70 per cent of vehicles in countries such asCambodia, Indonesia, the Lao People’s Democratic Republicand Viet Nam. 20In Kenya, between 1971 and 1990, pedestrians represented42 per cent of all traffic accident fatalities, andpedestrians and passengers combined accounted for approximately80 per cent of all fatalities each year. 21 In Nairobi(Kenya), between 1977 and 1994, 64 per cent of road userskilled in traffic crashes were pedestrians. 22 In Beijing(China), about one third of all traffic deaths occur amongbicyclists. 23Table 9.3Economic costs oftraffic accidents byworld region, 1997Source: Jacobs et al, 1999Box 9.1 The impact of traffic accidents on the urban poor in Bangladesh and IndiaA study of the differentiated impacts of road traffic accidents on households in Bangladesh and India clearly illustrates the association between traffic accidents and urbanpoverty. While the poor were not necessarily at greater risk of death or injury from traffic accidents, many urban households became poor following the death or injury ofa member.Breadwinners were most at risk in urban Bangladesh, where income from the urban poor killed by traffic accidents amounted, on average, to 62 per cent of theirhousehold’s total income. Likewise, Bangalore (India), poor households suffered disproportionately given that those killed by traffic accidents contributed 59 per cent of thehousehold income.Road crashes imposed a double financial burden on poor households. At the same time that they faced unexpected medical, if not funeral, costs, they also lost theincome of the victim and/or carer. Urban poor households in Bangladesh paid the equivalent of almost three months’ household income on funerals, a significantly greaterproportion of household income than the non-poor.Table 9.4 Household impacts of serious traffic accident injury in BangladeshConsequence of serious injury Urban poor * (percentage) Urban non-poor * (percentage)Income decreased Yes 57 33No 43 67Food consumption decreased Yes 59 25No 41 75Living standards decreased Yes 58 25No 42 75Arranged loan Yes 62 35No 38 65In contrast to non-poor households, the majority of urban poor households reported decreased income, food consumption and living standards. Most poor householdsalso borrowed money, thereby facing debt. Almost none of the households received insurance compensation, while only 13 per cent of the urban households received aprivate settlement.Source: Aeron-Thomas et al, 2004Note: * The poor were identified on the basis of official government estimates of poverty, household per capita income (not victim’s income alone) and post-crash household income (not pre-crash household income).