Mark Rosenberg, a New Threat to the Health of Women and Their Families: the Global Epidemic of Road Traffic Injuries

• Citation: Vol. 22 No. 1
• Publication year: 2008

A NEW THREAT TO THE HEALTH OF WOMEN AND THEIR FAMILIES: THE GLOBAL EPIDEMIC OF ROAD TRAFFIC INJURIES

Mark Rosenberg^*

I want to start with something that helped me get grounded, both literally and figuratively. This happened about a year and a half ago, and it was just four blocks from here. I live three blocks from here, and it was early in the morning. I was going to swim, and as I was driving up the street on which this law school sits, North Decatur Road, I thought I saw a body in the road. So I pulled off to the side, and very quickly I called 911. I said I think there's someone hurt, there's a body here. And then I ran out of the car, I ran over, and I found a young woman in the road just lying there. She was a runner. She'd been hit by a car, and had been hurt very badly. The woman who was driving pulled off a little farther up ahead. The young woman runner had a head injury and she was bleeding, but she was still alive.

I started doing CPR, and I thought if I can only keep her alive until the ambulance arrives. The ambulance arrived after about three minutes, and the technicians came over to me and said, "What do you want to do?" I said, "What do I want to do? You're the experts." They said, "No, you're the first doctor on the scene; it's your call." I said, "Intubate her. Take her in, take her to the hospital." And they said, "Look, look at that head injury. Look how serious that is. If you take her to the hospital, you're not going to do her any favor or her family any favor." I still wanted to take her in. They clearly didn't, and in a few minutes she just died right there in my hands. She was a young woman. It turned out she was the most famous runner in Atlanta, a young woman who had two children she was going back to, to get them ready to go to school. She was a young woman who was vulnerable because she was running in a pair of shorts, a shirt, and running shoes, and she was hit by a car, and there was nothing there to protect her. And she died. Right there.

She was one of 1.2 million people who are killed around the world each year in road traffic injuries. This is a new epidemic, and I wanted to present this to you to talk about not only what world law can do for improving health care, which is so important, but also to ask: Does world law have the potential to protect women like Patty Foell, who are running and get hit by a car? Can it not only deliver better health care, but can it also protect vulnerable women? Can it prevent this problem from happening in the first place? My hope and belief is that it can, but we haven't started to think enough about the protective value of world health law. We focus mostly on the ability to treat, but I want to think about this new area. I present this as a virgin problem because I am sure that either you haven't heard about this problem or you don't think that it's so bad.

I call this the "perfect plague": it's both perfectly predictable and perfectly preventable. It will place an extraordinary burden on women, first because the people who are injured the most in this epidemic are men-men going to work who are hit by cars, men who are vulnerable, much like Patty Foell. The women are left in families without the income of the breadwinner. Even worse, for every death, there are twenty to fifty serious injuries, so women are left with disabled men to take care of; and their children, without the income that the breadwinner could provide.

How big a problem could this really be, if we haven't really heard about it? Bigger than you can imagine. Road traffic injuries are exploding in developing countries. If you look at the curve here, what you see is that in high-income countries, the problem is getting better. Fewer and fewer people are killed on our roads. We brought it down to the point where, like AIDS in the 1990s, it was getting better in the U.S. and other developed countries, and we didn't think about it very much. It's come off the radar, and the same thing is happening here with this problem. But if you see what's happening, if you look at the Middle East, the rates are going up. In Africa, they're going up; in Latin America, faster; and in Asia, it's a frighteningly quick acceleration.

Why does this happen? If you look at the United States, what happens in most vehicle crashes is that very few people are killed. You can have 10,000 crashes in the U.S., and only sixty-six people will be killed. But if you look at Kenya, in 10,000 crashes, 1,800 people will be killed. In Vietnam, over 3,000 people out of 10,000 will be killed.

Why does it happen? It happens because in the United States, most of the people involved in crashes are riding in cars. We're very well protected. We have...