The World Health Report 2003 These consequences have a disproportionally adverse effect on the urban poor, because ur- ban areas have higher levels of pollution and often provide fewer options for physical activity( 39) Traffic injuries are also higher among the urban poor, as they tend to live in areas of higher traffic volume with a greater proportion of vehicles exceeding speed limits (40, 41). In addition, there is a clear relationship between degree of social and economic deprivation and risk of injury in children(42, 43). Reasons for these differences include the need for children of families without a car to cross a greater number of roads than children whose families own a car(44). These intra-urban inequalities provide a focus for policy action: reducing health risks among the poor is a powerful tool for poverty reduction(45) Policies adopted to reduce traffic-related air pollution do not usually consider the other health mpacts of traffic such as traffic crashes and injuries, and vice versa(46). Health systems have an important role to play in the development of integrated transport strategies that take account of all relevant health impacts(25). Health impasjicies and make suggestions on sessment tools can be used to how they can be modified to maximize overall health benefits and minimize health inequali- ties( 47). All of the subjects of the previous chapters in this report have one point in common: they represent major issues that cannot be successfully resolved without the benefit of a strong health system. The fate of the child with malaria in Africa, the middle-aged man with diabe- tes in Latin America, and the mother infected with HIV in Asia may all depend on the strength of their national health system. Chapter 7 finds that many such systems are sadly inadequate to cope with the challenges they face, and suggests initiatives to make them fit for the future Seewebsitehttpllwww.who.int/hia100 The World Health Report 2003 These consequences have a disproportionally adverse effect on the urban poor, because ur￾ban areas have higher levels of pollution and often provide fewer options for physical activity (39). Traffic injuries are also higher among the urban poor, as they tend to live in areas of higher traffic volume – with a greater proportion of vehicles exceeding speed limits (40, 41). In addition, there is a clear relationship between degree of social and economic deprivation and risk of injury in children (42, 43). Reasons for these differences include the need for children of families without a car to cross a greater number of roads than children whose families own a car (44). These intra-urban inequalities provide a focus for policy action: reducing health risks among the poor is a powerful tool for poverty reduction (45). Policies adopted to reduce traffic-related air pollution do not usually consider the other health impacts of traffic such as traffic crashes and injuries, and vice versa (46). Health systems have an important role to play in the development of integrated transport strategies that take account of all relevant health impacts (25). Health impact assessment tools1 can be used to help visualize the expected health implications of transport policies and make suggestions on how they can be modified to maximize overall health benefits and minimize health inequali￾ties (47). All of the subjects of the previous chapters in this report have one point in common: they represent major issues that cannot be successfully resolved without the benefit of a strong health system. The fate of the child with malaria in Africa, the middle-aged man with diabe￾tes in Latin America, and the mother infected with HIV in Asia may all depend on the strength of their national health system. Chapter 7 finds that many such systems are sadly inadequate to cope with the challenges they face, and suggests initiatives to make them fit for the future. 1 See web site http:\\www.who.int/hia