Road traffic deaths between social capital and health system: the Italian case

Abstract This paper analyses the relationship between social capital and road-traffic fatality rates, focusing on the role of healthcare capacity as a conditioning factor. Building on a crash-chain perspective, we argue that social capital primarily affects preventive behaviour and immediate post-crash responses, while healthcare capacity governs survival once an accident occurs, implying a context-dependent interaction between the two. Using regional panel data for Italy, we estimate models that explicitly account for the interaction between civic norms and healthcare resources. The results show that higher levels of social capital are associated with significantly lower road-traffic fatality rates. However, this association is heterogeneous across contexts: it is stronger in regions with weaker healthcare capacity and progressively attenuates as the healthcare system improves. Overall, the findings provide supportive evidence consistent with a mechanism of conditional complementarity between civic norms and healthcare capacity. Social capital appears to be particularly relevant where formal trauma care is limited, while its marginal contribution declines in resource-rich healthcare environments, with relevant implications for regional road-safety and public health policies.