Road Traffic Injuries

1
Road Traffic Injuries

• Review of risk factors and interventions

2
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
3
Background
Premature mortality in Western Cape (YLL) in 2000

• South Africa ahead of the curve
• In 2000 RTIs already contributed 5 of DALYs
• In Western Cape in 2000 RTIs contributed 6.9

Source Bradshaw et al. 2004, SANBD Study 2000
estimates of provincial mortality.
4
Road traffic fatalities by age and sex, Cape
Town, 2003 (n971)
5
Background
Mortality rate / 100, 000 population Western
Cape vs. National

• Similar to national average for males and females

Source Bradshaw et al. 2004, SANBD Study 2000
estimates of provincial mortality.
6
Background
Mortality rate / 100, 000 population Western
Cape vs. World average

• Approx. double world ave for males and females

Source Norman et al. in press. The high burden
of injuries in South Africa. WHO Bulletin. .
7
Road traffic mortality rates in Cape Town 2001 to
2004
Source Matzopoulos 2005. Sixth annual report of
the NIMSS
8
Background

• In Cape Town fatalities characterised by
• a high percentage of male deaths (78),
• a high percentage of pedestrian deaths (gt60),
• high alcohol relatedness among drivers (gt
  50),pedestrians (gt60),
• distinct weekend peaks among adults
• in the mornings and early afternoons among
  children of school going age

9
Pedestrian deaths by age and alcohol (n3475)
Cape Town 1994-2003
Source Matzopoulos 2005. Alcohol-related
pedestrian fatalities in Cape Town, South Africa
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Terminology

• Accidents vs collisions,injuries
• Collisions are predictable and preventable
• Accidents are acts of God
• Swedens Vision Zero - no one will be killed or
  seriously injured within the road transport
  system

11
Conceptual framework

• International road safety agencies typically
  utilise one of two common approaches
• The public health triad
• The systems approach
• The Burden of Disease projects other working
  groups use an ecological approach

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Public health approach
Host (injured person)
Environment (social, physical)
Vector (vehicle)
Agent (kinetic energy)
13
The systems approach

• factors influencing exposure to risk
• factors influencing crash involvement
• factors influencing crash severity

14
Marrying the systems and ecological approaches
Structural
Societal

• 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

Behavioural
Biological
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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

16
Traffic - Behavioural

• 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

• RISK FACTORS
• Alcohol and substance abuse
• Aggressive driving behaviours including speeding
  and moving violations among drivers and
  risktaking 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

17
Traffic - Societal

• RISK 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

18
Traffic - Structural

• RISK 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

19
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

20
Where to from here?

• Alignment and prioritisation
• Integration and monitoring
• Evaluation and evidence

21
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

22
Four priority areas for BoD

• Integrated incident reporting and management
  system
• Drunk driving
• Non-motorised transport
• Road safety academy

23
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.

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Driver deaths and alcohol City comparisons 2004
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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

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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.

• PGDS
• Economic 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.

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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