Health and road transport in Pakistan.
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.


METHODS
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.


CONCLUSIONS
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.
Hyder
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AA
Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Suite E-8132, 615 North Wolfe Street, Baltimore, MD 21205, USA. ahyder@jhsph.edu
Ghaffar
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AA
Sugerman
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DE
Masood
T I
TI
Ali
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L
D000063:Accidents, Traffic / Q000706:statistics & numerical data*; D001336:Automobiles; D006801:Humans; D008019:Life Style; D009624:Noise, Transportation / Q000009:adverse effects*; D010154:Pakistan / Q000453:epidemiology; D011640:Public Policy; D001335:Vehicle Emissions / Q000009:adverse effects*
D001335:Vehicle Emissions