Elsevier

Public Health

Volume 120, Issue 2, February 2006, Pages 132-141
Public Health

Original Research
Health and road transport in Pakistan

https://doi.org/10.1016/j.puhe.2005.03.008Get rights and content

Summary

Objective

The 1998 Global Burden of Disease Study estimated that road traffic injuries (RTIs) will become the third leading cause of lost disability-adjusted life years, with two-thirds of the deaths occurring in the least developed nations. Moreover, automobile-based transport systems are associated with air pollution (lead toxicity, asthma and greenhouse gas accumulation), noise disturbances, physical inactivity and obesity.

Study design

This study (1) reviewed road transport literature in Pakistan and the impacts on health outcomes; (2) examined health policies to assess their focus on transport-related health problems; and (3) identified policy gaps for future research.

Methods

A methodological review of the literature on direct and indirect effects of road transportation in Pakistan. This review includes government documents, memos, statements and draft policies as well as relevant articles indexed in MEDLINE.

Results

A systematic review revealed no approved transport policy in Pakistan, despite three national health policy documents. The Health Chapter of the 9th Five Year Plan appreciates the grave threat of unchecked RTI, but fails to offer specific policy interventions. Despite ambitious plans by the Pakistan Environmental Protection Agency, actual projects and their implementation remain scarce, resulting in ever-increasing air pollution. The health impact of lead toxicity, noise pollution and RTIs remain high, while obesity is on the rise.

Conclusion

The increasing health impact of road transport on 140 million people calls for immediate policy action. Government agencies must intervene effectively to establish monitoring and decentralised enforcement nationwide, while simultaneously supporting alternative modes of transportation.

Introduction

The Global Burden of Disease Study estimated that 10% of global deaths are due to injuries,1 with road traffic injuries (RTIs) likely to be the third most common cause of lost disability-adjusted life years within two decades.2 Currently, two-thirds of injury deaths occur in low-income countries (85% of the world's population)3 due to a wide array of risk factors that result in the lack of safety provisions at home, on the road and in the workplace. While developed countries have succeeded in decreasing the number of injuries, rates in developing countries continue to soar.

In addition to injuries, road-based transport systems are associated with an array of poor health outcomes that are exacerbated in developing nations. The most closely related health problems are caused by the effects of air pollution, lead toxicity and sedentary lifestyles. Caused by emissions and tyre burning,4, 5 air pollution can lead to childhood asthma,6 adult chronic obstructive pulmonary disease exacerbations, chronic bronchitis and increasing greenhouse gas emissions.7, 8 Leaded petrol leads to lead toxicity and subsequent reductions in child intelligence quotient, behaviour and hearing.9 Dependency on door-to-door motorised transport reduces walking and biking, thus contributing to obesity and its subsequent comorbid conditions (cardiovascular, musculoskeletal and endocrine).10, 11 In urban centres, high-vehicle density with loud engines and horn use can result in excessive noise pollution, which is associated with accelerated hearing loss and sleep degradation.12, 13 Finally, rising rates of traffic congestion can lead to increased stress levels, resulting in cardiovascular morbidity14 and lost work productivity. Despite these associations, only a handful of low-income nations currently monitor the negative impacts of road-based transport systems, despite continued expansion of vehicle ownership and road construction.

The aim of this study was to review the evidence (government and peer-reviewed) linking road transport and health in a developing country, using Pakistan as a case study. The specific objectives of this study were: (1) to review road transport policies in Pakistan and their documented impacts on health outcomes; (2) to review implemented road-transport-specific interventions; and (3) to identify gaps in policy and implementation for future research in the road transport sector.

Section snippets

Methods

This study was based on a systematic review of government and peer-reviewed literature regarding the road transport sector in Pakistan. The strategy for reviewing government documents was to contact the relevant government organisations directly in Pakistan. A formal request was submitted to the Ministry of Communications, which deals with road transport policies, oversees the National Transport Research Centre, and administratively controls the Pakistan Motorway Police and National Highway

Results

A systematic review of documents from the Ministry of Transport, Ministry of Health and the Planning Commission revealed that there has never been an approved transport policy in Pakistan. Three National Health Policy documents (1990, 1997, 2001) have been developed, but none of these identifies the transportation sector, including RTIs, motor vehicle emissions or road safety issues, as a public health problem.17 The Health Chapter of the 9th Five Year Plan16 and the 1997 National Health Policy

Discussion

There is evidence from the global literature that air pollution, lead toxicity, sedentary lifestyles and RTIs are outcomes of road-based transport, thus contributing significantly to the global burden of death and disability. The results of our study show that in Pakistan, there seems to be great need for a concerted effort on behalf of the government and civil society to emphasise this burden and implement appropriate actions. The quantity of work done in the country is limited, but includes

Acknowledgements

This paper was partly funded by a grant from the World Health Organisation, Geneva to AAH. The authors thank all individuals in Pakistan who helped with accessing documents.

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