**1. Introduction**

180 Health Management – Different Approaches and Solutions

Zhang Y et. Al. (1995). Worldwide On-Road Vehicle Exhaust Emissions Study by Remote

At the beginning of the XX century, Cuba's economy was not diversified or developed. The main source of income was sugar cane production, a technology which, seen from nowadays, could be considered almost artisanal. It involved an ox-driven mill which squeezed the juice out of the cane, first step in order to obtain sugar.

We must tie the development of the sugar cane, rum and the tobacco industries to the progressive increment of the number of vehicles, as they were also instrumental to that development. The first automobile that circulated in our country made it for the Havana streets in 1898, and it is said that the first accident reported in Cuba was in 1906, in which a pedestrian was implied. That brought along the fact that car accidents began to be considered the eighth cause of death in 1958, from being almost nonexistent (Dirección Nacional de Registros Médicos y Estadísticas de Salud [DNE], 2011).


Source: DNE, 2011.

Table 1. Deaths and mortality rate (by 100 000 inhabitants). Cuba 1958.

Epidemiology and Prevention of Traffic Accidents in Cuba 183

Traffic accidents mortality had an increasing trend in the 1970 to 1989 period as can be seen in fig.3, in which it soared up to 24.1 deaths by 100,000 habitants (Asamblea Nacional del Poder Popular, 1987; Ministerio de Salud Pública, 2010). Afterward it became evident its decrease down to 7.8 in 2008, which is related to changes in the national prevention strategy

3. Increased measures to avoid driving under influence (DUI) of alcoholic beverages. 4. Strengthening of the medical emergency system, increasing the number of ambulances

public transportation system (Ministerio del Transporte, 1999).

5. Public education throughout the broadcasting of many factors concurring in traffic

6. Mandatory technical supervision of motor vehicles, especially those involved in the

Source: ONE, 2010.

Source: ONE, 2010

accidents.

Fig. 1. Traffic accidents. Cuba 2004-2009

Fig. 2. Traffic accidents in cuban counties (2009)

as it is reflected in the 60 Act, which includes: 1. Mandatory use of helmets in motorbikes.

2. Mandatory use of safety belts.

and skilled medical personnel.

To the first clunker cars manufactured in North America, more vehicles were added predominantly from the United States, which in turn dictated the characteristics of the vehicle inventory. After 1959 vehicles coming from the extinct Soviet Union and others European countries were added to the stock. Starting 1990, there is an economical crisis the country must face against, resulting in important changes in the Cuban society, which in turn changed the way vehicles were employed due to fuel shortages. As an alternative transportation mean, bicycles are started to be used massively by the population to run their usual chores as well as to go to workplaces. At the same time animal-hauled vehicles, especially those using horses are starting to show up in cities throughout the country, less often in the nation's capital.

To remedy the shortcomings of the capital city's public transportation system, alternatives are sought as well, basically employing trucks and tractors without the required safety standards. Along this period, due to the same financial crisis which affected the public transportation system, the pavement of the city's thoroughfares began to deteriorate as well, along with the transit signals. All these factors increase the risks of car crashes and the injuries and casualties' toll.

Regarding the increased use of bicycles it should be stated that the modifications needed in the traffic system in order to protect bicycle riders -- as dedicated lanes or mandatory use of helmets -- were not immediately adopted.

However since the beginnings of the XXI century, the number of bicycles has dwindled significantly, which today circulates simultaneously to old built vehicles in North America in the fifties (e.g. Chevrolet, Chrisler), with others of European origin built in seventies (e.g. Lada, Moskvichs, Polski) and other more modern vehicles (e.g. Peugeot, Mercedes Benz, Toyota).
