Motorcycle helmet wearing in Viet Nam ..... is the job done?

Jonathon Passmore

Technical Officer, Road Safety and Injury Prevention, WHO Viet Nam

This presentation UPDATE

• Overview – road traffic injuries in Viet Nam• Motorisation in Viet Nam• Prevalence of major risk factors• Road safety enforcement• WHO support to road safety in Viet Nam

RTI as leading cause of death

Source : VINE Project 2008

Source : WHO GBD 2004

Disability Adjusted Life Years (DALYs)

Source : VINE Project 2008

Years of Life Lost (YLL)

Source : VINE Project 2008

Road safety management

PRIME MINISTER

National Traffic Safety Committee

DEPUTY PRIME MINISTER

Standing OfficeSecretariat63 Provincial TSC’s

Public private partners

National Mass Organisations

International Organizations

Minister of Transport Vice Minister Public Security

Road trauma in Viet Nam

NTSC/MPS MOH

Road traffic deaths (2009) 11,094 15,012

Road traffic injuries (2010) 10,306 435,181

Mortality rate 12.9/100K 17.4/100K

0

5,000

10,000

15,000

20,000

25,000

30,000

35,000

1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

# of road crashes Deaths Injured

Road traffic injury mortality by province, 2008

• Large variation in mortality rates• Anecdotally associated with major

transport hubs (national/international roads)

30+

20-29

10-19

0-9

Motorization in Viet Nam

• 33.2 million vehicles in Viet Nam (2010)– 95% motorcycles– > 8,000 new motorcycles per day– > 500 new cars per day

0

5,000,000

10,000,000

15,000,000

20,000,000

25,000,000

30,000,000

35,000,000

1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010

Motorcycles Cars, Buses, Trucks

History of helmet legislation in Viet Nam

1995 Decree 36

2010Decree 34 (penalties)Wearing for children

1997 NTSC formed

2001TCVN helmet standards

for adults & childrenRS Law

MOT Circ Decree 39 (penalty)

2007Resolution 32

Mandatory helmet wearing

1998-2000TCVN helmet standards

for adults & childrenRS Law

2009 Revised RS law

Helmet wearing full law Fastening

2008QCVN standards

revised Single standard

covering adults & children

National helmet law

Pre law

Post law

15 December 2007: Helmet Law+ Enforcement + Education

What contributed to the success this time?

• Political support– Highest level (Prime Ministers Office & the Party)– Whole of Government approach (NTSC coordinated)

• Demonstrated effectiveness of helmets– Confidence a helmet law could be successful if implemented correctly

• Implemented in effective manner– Strict penalties (10 fold increase)– Advance social marketing and public education– Civil service role models

• 4 million citizens, plus members of the armedforces

– Stringent and consistent enforcement• high perception of being caught

– Reduced confusion of coverage• all roads, all times, all riders and passengers

– Availability of affordable, climatically appropriate helmets

Roles for individual members of NTSC

Ministry of TransportCoordinated development of legislation; instructing other members of the NTSC, and

the 63 PTSC on implementation of the law

Ministry of Public Securitynationwide instruction to all police to ensure that enforcement was thoroughly

implemented

Ministry of Health hospital based surveillance system for road traffic injuries

Ministry of Education and TrainingSchool based education on the benefits of helmet wearing

Ministry of Communication and Information Delivery of mass media social marketing campaign through official channels

including daily road safety programming on national TV

Social marketing

• NTSC commenced SM campaigns in 1998

• In 2007, partnerships with AIPF commenced targeted campaigns

– TV, Cinema, Posters, Billboards, bus shelters etc

Social marketing

Social marketing

Social marketing

Enforcement for road safety

• 10 fold increase in penalties for not wearing helmet– from 20-40K VND (≈USD 1-2)

(2005) to 100-200K VND (≈USD 6-12) per offence

• Total traffic infringements 5,431,191– 682,789 (13%) for not wearing

helmets– No reliable data available for 2007

• Ongoing challenge– Human resources – Maintaining the high levels of

enforcement necessary

Infringements – All infringements vs helmets only

5,431,1915,589,635

6,362,907

682,789526,510

940,601

0

1,000,000

2,000,000

3,000,000

4,000,000

5,000,000

6,000,000

7,000,000

2008 2009 2010

infr

ing

emen

ts

Total infringements Helmet wearing violations

Motorcycle helmet wearing –long term trend

72.9

88.1

81.980.7

91.0

85.4

27.5

99.5 99.0 98.0 99.0 98.9

47.9

94.396.4 96.0

97.9

93.9

50.7

80.2

62.5

65.2

75.272.8

21.7

97.5

86.884.6

91.6

86.8

42.1

87.6

90.6 90.3

94.6

87.6

0

20

40

60

80

100

120

Nov-07 Jun-08 Dec-08 May-09 Sep-09 Feb-11 Nov-07 Jun-08 Dec-08 May-09 Sep-09 Feb-11 Nov-07 Jun-08 Dec-08 May-09 Sep-09 Feb-11

Yen Bai Da Nang Binh Duong

Riders Passengers

Motorcycle helmet wearing –long term trend

• Helmet wearing has increased substantial since the 2007 helmet law and high wearing rates have been maintained since

BUT

• Issues of low helmet quality and not wearing helmets correctly have the potential to seriously impact the injury prevention potential of this legislation and the fact that the majority of motorcycle riders and passengers are wearing helmets

Wearing rates in Hanoi

Pre/post law impact

• Very limited information on impact of helmet law

• Data on all road users, no breakdown for MC riders and passengers only

• 2008 vs 2007– 1,557 ↓ death– 2,495 ↓ serious injuries

• 2009 vs 2008– 149↓ death– 212 ↓ serious injury

• 2010 vs 2009– 65↓ death– 2747 ↑ serious injury

Deaths Serious injuries

2007 12,800 11,097

2008 11,243 7,771

2009 11,094 7,559

2010 11,029 10,306

2011* 8,903 8,055

* Jan-Oct

Pre/post law impact – Health data

• National injury surveillance system in operation• Commenced 2008

• No pre law data

• Declining reporting since• 2008 - 92/100 hospitals• 2009 – 84/100 hospitals• 2010 - 43/100 hospitals

2008 2009 2010

Road traffic injuries 183,058 143,940 117,317

% of RTI with head injuries

27.1% 25.3% 17.8%

Hospital records - Head injuries

20,925

19,280

17,813

6,639

5,399

17,940

20,13019,881 19,501

7,326

8,084

7,298

7,3297,372

-

5,000

10,000

15,000

20,000

25,000

2004 2005 2006 2007 2008 2009 2010

Road traffic injuries

Road traffic head injuries

Pre/post law impact – Health data

% change RR 95% CI

All injuries 2007 vs 2008 -1.04% 0.98* 0.97-0.99

2007 vs 2010 -5.82% 0.88* 0.87-0.89

Road traffic injuries 2007 vs 2008 -3.16% 0.95* 0.94-0.96

2007 vs 2010 -1.68% 0.89* 0.87-0.91

RT patients with head injuries 2007 vs 2008 -0.64% 0.98 0.96-1.01

2007 vs 2010 -7.69% 0.78* 0.76-0.81

RT fatalities 2007 vs 2008 -0.16% 0.76* 0.59-0.99

2007 vs 2010 0.32% 1.25 0.99-1.56

* P<0.05

• Limitations of aggregate data• No breakdown by age and sex• No breakdown by road user type (cant identify MC riders and passengers as a

proportion of head injuries)

Helmet legislation loopholes

• Low wearing rate among children <16 years

• 39%, 2008 (AIPF)

• 30%, May 2010 (HSPH & WHO)

• 21% December 2010 (HSPH & WHO)

• Many parents believe helmets are dangerous for children

• Adults can now be penalised however negligible enforcement

• Incorrect helmet wearing

• Dec 15 law contained no ability to enforce unfastened helmets

• Revised Nov 13 2008, police define un-fastened as un-worn

• Low quality helmet

• Only 20% meeting standard (VINASTAS)

• Surveys in major cities estimate 30% & 45% meeting standards

• High use of banned “cap” style helmets

• New standards Nov 15 2008

Helmet wearing in primary school aged children

0.0%

10.0%

20.0%30.0%

40.0%

50.0%

60.0%

70.0%80.0%

90.0%

100.0%

2009 2010 2009 2010 2009 2010 2009 2010

Yen Bai Hanoi Da Nang Can Tho

Correct Incorrect No helmet

Helmet wearing in secondary school aged children

Child helmet wearing February 2011 (weekday)

Child helmet wearing, February 2011 (weekend)

Current follow up

• Atlantic Philanthropies funding AIPF & NTSC to implement a national social marketing program in 2011

• Through grant from AP, WHO are complement public education program with enhanced enforcement program with police

Quality of standard helmets

• Road side surveys show that

high rates of helmet wearing are

being maintained but the proportion of those wearing low quality non-standard helmets continues to grow

Ha Nam

Ninh Binh

Bac Giang

Wearing (%) Motorcycle riders

83.8% 82.3% 91%

Wearing (%) Motorcycle passengers

73.4% 77.7% 85%

BUT% of riders wearing non- standard helmets

46.4% 11.5% 30.6%

% of passengers wearing non- standard helmets

50.2% 15.1% 40.2%

Latest results from June 2011

Quality of standard helmets

Some helmets are better than others!

Helmet standards - Tropical vs ECE 22

QCVN2: 2008• High degree of impact protection• Accepted, affordable, climatically

appropriate to conditions in Viet Nam

• ECE 22• Higher degree of impact protection• ≈USD 30• Not affordable in Viet Nam or relevant to

climatic conditions

Helmet standards - Tropical vs ECE 22

QCVN2 TCVN ECE 22

Drop tower system

Monorail Monorail Free motion

Drop height 1500mm 1830mm (flat

anvil), 1385mm (hemispherical)

7.5 m/s onto flat/kerbstone

anvil,

Maximum acceleration

< 225g (<300 circ < 500mm)

<300g < 275 g

How does a helmet protect the brain?

How does a helmet protect the brain?

How does a helmet protect the brain?

What's coming?

• Late 2011– Viet Nam National Injury Survey– Helmet quality survey

• 2012– Retrospective (2006-2011) records study of head injuries in

major hospitals nationwide

Acknowledgements

• National Traffic Safety Committee (NTSC) and all Government agencies responsible for the development and implementation of the helmet legislation

• Hanoi School of Public Health (data collection)

• Asia Injury Prevention Foundation (social marketing materials)

References

• Pervin A, Passmore J, Sidik M, McKinley T, Nguyen THT, Nguyen PN. Viet Nam's mandatory motorcycle helmet law and its impact on children. Bull World Health Organ 2009;87:369-73.

• Passmore J, Nguyen THT, Luong MA, Nguyen DC, Nguyen PN. Impact of mandatory motorcycle helmet wearing legislation on head injuries in Viet Nam: results of a preliminary analysis. Traffic Inj Prev 2010;11:206-2010

• Passmore J, Nguyen LH, Nguyen NP & Olivé J. The formulation and implementation of a national helmet law: a case study from Viet Nam. Bull World Health Organ 2010;88:783-787.

Copies available

THANK YOU

passmorej@wpro.who.int