Cairo’s traffic problems are costing Egypt around 4 per cent of its GDP

Traffic returns to Cairo’s Tahrir square following demonstrations in 2012. Image: Getty.

Last year, a documentary about Cairo won the prize for best Arab documentary at the Abu Dhabi film festival. It covers the period from 2009 to 2012, a time in which the Arab spring sprung, a revolution overturned Egypt's government, and the country’s first democratic elections took place.

 

But Cairo Drive isn’t a film about politics. It’s a film about traffic.

Traffic can seem to define Cairoites’ lives, not least because so much of them play out in cars, sitting stationary in traffic. The city is home to 20m people, 2m cars and 23,6000 miles of road. Long waits and terrible traffic jams mean many socialise through open windows, trading insults, cigarettes and small talk. One of the film's stars points out that for young men, who tend to live with their parents until marriage, their cars are the only space they have to themselves: "It's the place where you kick it with your friends."

Traffic laws are largely ignored, and drivers take their cues to stop and go through a language of honking (most honks, it turns out, translate as insults about other drivers' mothers). As another of the film’s subjects puts it: "It's like that Frank Sinatra song, 'Do it My Way'. We all just do it our way".

The endless honking and chatting seems quite fun, but there’s another side to the traffic. It blocks ambulances, kills pedestrians and causes horrible pileups, especially on the city's ring-road. Originally built to ease congestion, this road is now used just as recklessly as the city's other routes, and at higher speeds. One mother featured in the film is so worried about the ring road that she sits in the car with her son on his journeys to and from school, pointing out speeders or swervers to her driver from the edge of her seat.

The World Bank carried out a study on Cairo’s traffic problems in 2010. It found that the annual cost of congestion in the greater metropolitan area amounted to around 50 billion Egyptian dollars a year: 4 per cent of Egypt’s entire GDP. Even Jakarta, also densely populated, famous for its traffic and rapidly expanding, only loses 0.6 per cent of Indonesia’s GDP to traffic costs.

The study recommended cutting back the fuel subsidies, which make up a fifth of the Egypt’s government budget; it also wanted improvements to public transport and pedestrian routes, and a significant investment in traffic lights. Earlier this year, Hartwig Schafe, the World Bank’s director for Egypt, suggested similar solutions in a post for Ahram Online.

Fuel subsidies across Egypt were cut this year, increasing the price of gasoline by over 70 per cent and sparking protests. But some of the government’s other attempts to tackle the problem don’t quite match the World Bank’s proposals. One recent road education campaign in schools involved students sitting at a red light in a toy car, explaining that they won't rush, even though they're late. They sing a traffic lights song, with lyrics that run:

"Yellow, yellow, yellow means wait, wait, wait...even if you're late, late late."

For Sherief Elkhatsha, the film’s creator and director, traffic was a focus in itself, but also acted as a route into other issues. His subjects were often suspicious of filming, and, as he told an audience at a screening of the film at the Barbican last week, many cautiously said they “didn’t want to talk about politics”. “Of course,” he continued, “we’d by start talking about traffic and then, ten minutes later, they’d be onto politics.”

His hunch was that traffic plays a central role in politics and city life: each major event since 2009 has brought with it a change in the city’s traffic patterns. During the revolution, when police were absent from the city’s roads, citizens took to directing traffic themselves, and for a short period, drivers appeared to be following road laws. Yet, as Elkatsha noted at the screening, the situation soon regressed: “People took democracy to mean their freedom alone. It ends at the tip of someone else’s nose, so they could drive however they wanted.”

 How has the political situation in Cairo changed in the past couple of years, Elkhatsha was asked. “All I can say is that traffic is slightly worse,” he replied.

 
 
 
 

What’s killing northerners?

The Angel of the North. Image: Getty.

There is a stark disparity in wealth and health between people in the north and south of England, commonly referred to as England’s “north-south divide”. The causes of this inequality are complex; it’s influenced by the environment, jobs, migration and lifestyle factors – as well as the long-term political power imbalances, which have concentrated resources and investment in the south, especially in and around London.

Life expectancy is also lower in the north, mainly because the region is more deprived. But new analysis of national mortality data highlights a shockingly large mortality gap between young adults, aged 25 to 44, living in the north and south of England. This gap first emerged in the late 1990s, and seems to have been growing ever since.

In 1995, there were 2% more deaths among northerners aged 25 to 34 than southerners (in other words, 2% “excess mortality”). But by 2015, northerners in this age group were 29% more likely to die than their southern counterparts. Likewise, in the 35 to 44 age group, there was 3% difference in mortality between northerners and southerners in 1995. But by 2015, there were 49% more deaths among northerners than southerners in this age group.

Excess mortality in the north compared with south of England by age groups, from 1965 to 2015. Follow the lines to see that people born around 1980 are the ones most affected around 2015.

While mortality increased among northerners aged 25 to 34, and plateaued among 35 to 44-year-olds, southern mortality mainly declined across both age groups. Overall, between 2014 and 2016, northerners aged 25 to 44 were 41% more likely to die than southerners in the same age group. In real terms, this means that between 2014 and 2016, 1,881 more women and 3,530 more men aged between 25 and 44 years died in the north, than in the south.

What’s killing northerners?

To understand what’s driving this mortality gap among young adults, our team of researchers looked at the causes of death from 2014 to 2016, and sorted them into eight groups: accidents, alcohol related, cardiovascular related (heart conditions, diabetes, obesity and so on), suicide, drug related, breast cancer, other cancers and other causes.

Controlling for the age and sex of the population in the north and the south, we found that it was mostly the deaths of northern men contributing to the difference in mortality – and these deaths were caused mainly by cardiovascular conditions, alcohol and drug misuse. Accidents (for men) and cancer (for women) also played important roles.

From 2014 to 2016, northerners were 47% more likely to die for cardiovascular reasons, 109% for alcohol misuse and 60% for drug misuse, across both men and women aged 25 to 44 years old. Although the national rate of death from cardiovascular reasons has dropped since 1981, the longstanding gap between north and south remains.

Death and deprivation

The gap in life expectancy between north and south is usually put down to socioeconomic deprivation. We considered further data for 2016, to find out if this held true for deaths among young people. We found that, while two thirds of the gap were explained by the fact that people lived in deprived areas, the remaining one third could be caused by some unmeasured form of deprivation, or by differences in culture, infrastructure, migration or extreme weather.

Mortality for people aged 25 to 44 years in 2016, at small area geographical level for the whole of England.

Northern men faced a higher risk of dying young than northern women – partly because overall mortality rates are higher for men than for women, pretty much at every age, but also because men tend to be more susceptible to socioeconomic pressures. Although anachronistic, the expectation to have a job and be able to sustain a family weighs more on men. Accidents, alcohol misuse, drug misuse and suicide are all strongly associated with low socioeconomic status.

Suicide risk is twice as high among the most deprived men, compared to the most affluent. Suicide risk has also been associated with unemployment, and substantial increases in suicide have been observed during periods of recession – especially among men. Further evidence tells us that unskilled men between ages 25 and 39 are between ten and 20 times more likely to die from alcohol-related causes, compared to professionals.

Alcohol underpins the steep increase in liver cirrhosis deaths in Britain from the 1990s – which is when the north-south divide in mortality between people aged 25 to 44 also started to emerge. Previous research has shown that men in this age group, who live in the most deprived areas, are five times more likely to die from alcohol-related diseases than those in the most affluent areas. For women in deprived areas, the risk is four times greater.


It’s also widely known that mortality rates for cancer are higher in more deprived areas, and people have worse survival rates in places where smoking and alcohol abuse is more prevalent. Heroin and crack cocaine addiction and deaths from drug overdoses are also strongly associated with deprivation.

The greater number of deaths from accidents in the north should be considered in the context of transport infrastructure investment, which is heavily skewed towards the south – especially London, which enjoys the lowest mortality in the country. What’s more, if reliable and affordable public transport is not available, people will drive more and expose themselves to higher risk of an accident.

Deaths for young adults in the north of England have been increasing compared to those in the south since the late 1990s, creating new health divides between England’s regions. It seems that persistent social, economic and health inequalities are responsible for a growing trend of psychological distress, despair and risk taking among young northerners. Without major changes, the extreme concentration of power, wealth and opportunity in the south will continue to damage people’s health, and worsen the north-south divide.

The Conversation

Evangelos Kontopantelis, Professor in Data Science and Health Services Research, University of Manchester

This article is republished from The Conversation under a Creative Commons license. Read the original article.