Road Traffic Injuries Review of risk factors and interventions.
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Transcript of Road Traffic Injuries Review of risk factors and interventions.
Road Traffic Injuries
Review of risk factors and interventions
Background
Road traffic injuries an emerging priority internationally Contribution to global BoD rising to 5.1% by 2020 Esp in LMICs: rapid motorisation, decrease in other causes
Source: Peden et al. 2002. The injury chart book
Background
2.3
2.3
2.4
2.7
4.6
5.9
6.9
7.9
12.9
14.1
Diarrhoeal disease
Suicide
Lower resp infects
Trachea/bronchi/lung ca
Stroke
Ischaemic heart disease
Road traffic injuries
Tuberculosis
Homicide/violence
HIV/AIDS
Premature mortality in Western Cape (YLL) in 2000
Source: Bradshaw et al. 2004, SANBD Study 2000: estimates of provincial mortality.
South Africa ahead of the curve In 2000 RTIs already contributed 5% of DALYs In Western Cape in 2000 RTIs contributed 6.9%
Road traffic fatalities by age and sex, Cape Town, 2003 (n=971)
0
50
100
150
200
250
<1 1-4
5-9
10-
14
15-
19
20-
24
25-
29
30-
34
35-
39
40-
44
45-
49
50-
54
55-
59
60-
64 65+
Age in years
Num
ber
of d
eath
sMale Female
BackgroundMortality rate / 100, 000 population Western Cape vs. National
0
10
20
30
40
50
60
70
Males Females
National Western Cape
Source: Bradshaw et al. 2004, SANBD Study 2000: estimates of provincial mortality.
Similar to national average for males and females
BackgroundMortality rate / 100, 000 population Western Cape vs. World average
Approx. double world ave for males and females
0
10
20
30
40
50
60
70
Males Females
World Western Cape
Source: Norman et al. in press. The high burden of injuries in South Africa. WHO Bulletin. .
Road traffic mortality rates in Cape Town 2001 to 2004
0
10
20
30
40
2001 2002 2003 2004
Age
sta
ndar
dise
d m
orta
lity
rate
per
10
0,00
0 po
pula
tion
Source: Matzopoulos 2005. Sixth annual report of the NIMSS
Background
In Cape Town fatalities characterised by a high percentage of male deaths (78%), a high percentage of pedestrian deaths
(>60%), high alcohol relatedness among drivers (>
50%),pedestrians (>60%), distinct weekend peaks among adults in the mornings and early afternoons among
children of school going age
Pedestrian deaths by age and alcohol (n=3475)
0
100
200
300
400
500
600
700
800
900
1000
0-9 '10-19 20-29 30-39 40-49 50-59 60-69 70-79 80+years
No. of fatalitiessoberBAC +ve
Cape Town 1994-2003
Source: Matzopoulos 2005. Alcohol-related pedestrian fatalities in Cape Town, South Africa
Terminology “Accidents” vs “collisions”,“injuries”
Collisions are predictable and preventable
Accidents are “acts of God”
Sweden’s Vision Zero - no one will be killed or seriously injured within the road transport system
Conceptual framework
International road safety agencies typically utilise one of two common approaches:
The public health triad The systems approach
The Burden of Disease project’s other working groups use an ecological approach
Public health approach
Vector(vehicle)
Agent(kinetic energy)
Host(injured person)Environment
(social, physical)
The systems approach
• factors influencing exposure to risk
• factors influencing crash involvement
• factors influencing crash severity
Marrying the systems and ecological approaches
Factors influencing exposure to risk mainly infrastructural / upstream social factors
Factors influencing crash involvement mainly individual biological or behavioural except inadequate visibility defects in road design (both infrastructural).
Risk factors influencing crash severity are a true mix
Structural Societal
Behavioural Biological
Traffic - Biological
RISK FACTORS Demographic factors such as
age (young for aggression, old for decreased alertness and sex for aggression
Other biological factors: a variety of acute and chronic conditions that may pose a risk to the driver passengers and other road users, such as epilepsy, neurological disorders; heart disease; poor eyesight
INTERVENTIONS Graduated driver license
system for new drivers. Restricted licenses for
young drivers (especially young males)
Improved licensing system geared to health and behavioural problems based on examination etc
Monitoring and evaluation of process, output and outcome indicators
Traffic - BehaviouralRISK FACTORS Alcohol and substance abuse Aggressive driving
behaviours including speeding and moving violations among drivers and risk–taking behaviour by all road users
Fatigue Cell-phones Seat-belts and child restraints
not used Crash helmets not worn by
users of two-wheeled vehicles
INTERVENTIONS Vigorous and regular random breath
testing Better admin and follow-up of fines – only
17% of fines are paid Compulsory courses/training for
substance abusers Stricter enforcement with more severe
penalties Visible enforcement of moving and other
violations Education campaigns at various locations
and via various media that are integrated with current enforcement priorities
Monitoring and evaluation of process, output and outcome indicators
Traffic - SocietalRISK FACTORS Socio-cultural factors:
e.g the role of the media in prompting glamorising unsafe behaviours and unrealistic lifestyle choices
e.g. advertising fast unsafe cars as status symbols
Culture of lawlessness Poor rule of law and ineffective
enforcement
INTERVENTIONS Educational policies Advertising policies for the motor
industry restraining harmful advertising (speed, environmental damage, macho image) as for tobacco and alcohol
Policy to prevent culture of impunity
Demerits and confiscation Occupational health regulation for
professional drivers iro fatigue and driver medicals (same could be applied to other drivers)
Cost benefit and multi-criteria analyses and constant monitoring and evaluation
Traffic - StructuralRISK FACTORS Economic factors - social deprivation and poverty Land use planning - poor access to employment and services Urbanisation and inadequate basic infrastructure Limited opportunities for safer modes of travel Mixture of high-speed and vulnerable road users Insufficient attention to integration of road function, speed limits, road layout
and design, etc Large number of vulnerable road users (e.g. pedestrian) in urban and
residential areas Travelling in darkness Defects in road design, layout and maintenance Inadequate visibility Roadside objects not crash protective
Traffic - Structural
INTERVENTIONS Spatial development and planning policies Policy and law regarding motor vehicle design Independent safety audits of infrastructure Regulate advertising in media that emphasises speed etc and
restrict general advertising that distracts drivers Policies to increase visibility
lights-on for daytime travel, street lighting at night to increase visibility
retro-reflective components in school wear Vehicle safety and operation standards rigorously maintained by
law
Where to from here?
Alignment and prioritisation
Integration and monitoring
Evaluation and evidence
Alignment
Congruence with 5/8 strategies of iKapa Elihlumayo: economic participation connectivity infrastructure effective transport liveable communities spatial integration
2007/2008 WC Provincial Programme of Action
Shared Growth and Integrated Development
Indicators for Provincial Growth Development Strategy
State of Province priorities
Four priority areas for BoD
Integrated incident reporting and management system
Drunk driving
Non-motorised transport
Road safety academy
Incident reporting and management system Coherent and comprehensive surveillance system
combining traffic management and health outcome data - PIMSS, SAPS, DoT and EMS data
Enhanced geo-spatial to target high risk areas
Include other data sources? E.g. insurance companies and vehicle tracker data
PGDS Government and Administration Cluster
- Priorities 2.3, 3.1 and 4.2
Social Cluster - Emergency Medical Services (2.4.1)- FIFA World Cup 2010 Disaster Management (1.7.6)
State of the Province
Public Transport Human Settlements
2010 priorities.
Driver deaths and alcohol City comparisons 2004
0%
50%
100%
Johannesburg Durban Cape Town Tshwane/Pretoria
Zero 0.01 – 0.04 0.05 – 0.14 0.15 – 0.24 >0.25
0%
50%
100%
Johannesburg Durban Cape Town Tshwane/Pretoria
Zero 0.01 – 0.04 0.05 – 0.14 0.15 – 0.24 >0.25
Drunk driving Aggressive implementation of drunk driving legislation. Regular random breath testing targeting high risk
times and locations. Integrated messaging in media and awareness raising
at liquor outlets, shebeens, etc. Monitoring and evaluation:
random breath test data BAC data from provincial mortality surveillance.
PGDS Social Cluster
-Substance abuse (1.5.3)-Anti-crime strategy (6.1)-Motor Vehicle Accident Intervention Strategy (6.2)
State of the Province?
Human Settlements
2010 priorities
Non-motorised transport
Integration of best practices for non-motorised transport.
UCT has access to international access and experience with regards to cycling through the Cycling Academia Network includes safety as one of its eight core
themes.
PGDSEconomic Cluster
-Integrated Transport Priorities 2.4.6, 2.4.10 , 2.4.12-Motor Vehicle Accident Intervention Strategy 6.2
State of the Province? Public Transport Human Settlements
2010 priorities.
Road safety academy
feasibility study for road safety academy
a national resource for all road safety training initiatives, incorporating e.g. police and traffic officers, educators,
emergency medical services, etc. review materials of different stakeholder groups Integrate international, national, provincial and local
initiatives review funding options to ensure long-term sustainability
PGDS Social Cluster
-Motor Vehicle Accident (stet) Intervention Strategy 6.2
State of the Province Human Settlements
2010 priorities