Essays on the health and welfare impacts of road transport in low- and middle-income countries

This thesis consists of four essays at the intersection of transport and health with the underlying theme of exploring the effects of road infrastructure and road transport externalities on household health and welfare in low- and middle-income countries. Chapter 2 is a literature review of the pathways through which road transport affects health and methods that are used to estimate these effects. The results reveal extensive inconsistencies regarding aspects of that are health evaluated, methods used, and the values attached to health impacts in both government documents and published literature. Chapter 3 estimates the impact of road traffic injuries on household welfare. The chapter applies a mix of genetic matching and multilevel modelling techniques to isolate effects of Road Traffic Injuries (RTIs) on household health expenditure, non-health consumption expenditure, asset ownership, household indebtedness and labour force participation. Results suggest that RTI affected households incurred significantly higher health expenditure, reduced expenditure on competing basic needs and faced a higher likelihood to borrow at positive interest rates to purchase health services. The fourth chapter analyses the effects of upgrading earthen roads to a paved status on the cost of travel to seek health services, level of health services utilization, incidence of Respiratory Illness (RI), and level of household consumption expenditure. Results suggest that households nearer to a road development project reported higher consumption but were more prone to RIs. The impacts on transportation costs and level of health care utilisation were negligible. Chapter 5 is an economic evaluation of a road decongestion infrastructure project. The objective is first to assess how inclusion of health impact frequently omitted in transport cost benefit analysis (CBA) influences the decision to invest. Secondly, to determine, in a Cost-Effectiveness Analysis (CEA) framework, whether transport projects such as this one, would represent value for money if solely considered for their potential as interventions to prevent health loss. The analyses demonstrate that decisions to invest may be largely influenced by cross-sector impacts that the evaluator chooses or is able to include in the decision model. The chapter also highlights the significance of consistency in choice of approaches used to value aspects of intervention impacts, especially where the projects are being compared and ranked.