Road Traffic Injuries Review of risk factors and

Road Traffic Injuries Review of risk factors and interventions

Background ¢ Road traffic injuries an emerging priority internationally l Contribution to global Bo. D rising to 5. 1% by 2020 l Esp in LMICs: rapid motorisation, decrease in other causes Source: Peden et al. 2002. The injury chart book

Background Premature mortality in Western Cape (YLL) in 2000 ¢ South Africa ahead of the curve l In 2000 RTIs already contributed 5% of DALYs l In Western Cape in 2000 RTIs contributed 6. 9% Source: Bradshaw et al. 2004, SANBD Study 2000: estimates of provincial mortality.

Road traffic fatalities by age and sex, Cape Town, 2003 (n=971)

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.

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.

Road traffic mortality rates in Cape Town 2001 to 2004 Source: Matzopoulos 2005. Sixth annual report of the NIMSS

Background ¢ In Cape Town fatalities characterised by l l l 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) 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 Environment (social, physical) Vector (vehicle) Host (injured person) Agent (kinetic energy)

The systems approach • factors influencing exposure to risk • factors influencing crash involvement • factors influencing crash severity

Marrying the systems and ecological approaches Structural ¢ Factors influencing exposure to risk mainly infrastructural / upstream social factors ¢ Factors influencing crash involvement mainly individual biological or behavioural except l inadequate visibility l defects in road design (both infrastructural). ¢ Risk factors influencing crash severity are a true mix Behavioural Societal 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 - Behavioural RISK 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 - Societal RISK FACTORS INTERVENTIONS ¢ Socio-cultural factors: ¢ Educational policies l e. g the role of the media in ¢ Advertising policies for the motor prompting glamorising unsafe industry restraining harmful behaviours and unrealistic lifestyleadvertising (speed, environmental choices damage, macho image) as for l e. g. advertising fast unsafe cars tobacco and alcohol as status symbols ¢ Policy to prevent culture of impunity ¢ Culture of lawlessness ¢ Demerits and confiscation ¢ Poor rule of law and ineffective enforcement ¢ 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 - 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

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 l l ¢ 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 i. Kapa Elihlumayo: l economic participation l connectivity infrastructure l effective transport l liveable communities l 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 Bo. D ¢ 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, Do. T 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

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: l random breath test data l 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 nonmotorised transport. UCT has access to international access and experience with regards to cycling through the Cycling Academia Network l 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.

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, 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