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