Transcript Road Traffic Injuries - Western Cape Government

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
Premature mortality in Western Cape (YLL) in 2000
14.1
HIV/AIDS
12.9
Homicide/violence
7.9
Tuberculosis
6.9
Road traffic injuries
5.9
Ischaemic heart disease
4.6
Stroke
Trachea/bronchi/lung ca
2.7
Lower resp infects
2.4
Suicide
2.3
Diarrhoeal disease
2.3
 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.
Road traffic fatalities by age
and sex, Cape Town, 2003
(n=971)
Male
Female
200
150
100
50
10
-1
4
15
-1
9
20
-2
4
25
-2
9
30
-3
4
35
-3
9
40
-4
4
45
-4
9
50
-5
4
55
-5
9
60
-6
4
65
+
59
14
0
<1
Number of deaths
250
Age in years
Background
Mortality rate / 100, 000 population
Western Cape vs. National
70
60
50
40
30
20
10
0
Males
National
Females
Western Cape
 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
70
60
50
40
30
20
10
0
Males
World
Females
Western Cape
 Approx. double world ave for males and females
Source: Norman et al. in press. The high burden of injuries in South Africa. WHO Bulletin.
Age standardised mortality rate per
100,000 population
Road traffic mortality rates in
Cape Town 2001 to 2004
40
30
20
10
0
2001
2002
2003
Source: Matzopoulos 2005. Sixth annual report of the NIMSS
2004
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)
No. of fatalities
sober
BAC +ve
1000
900
800
700
600
500
400
300
200
100
0
0-9
'10-19
20-29
30-39
40-49
years
50-59
60-69
70-79
80+
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
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
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
 e.g the role of the media in
 Advertising policies for the motor
prompting glamorising unsafe
industry restraining harmful
behaviours and unrealistic
advertising (speed, environmental
lifestyle choices
damage, macho image) as for
 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
 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
State of the Province
 Public Transport
Human Settlements
 Social Cluster
- Emergency Medical Services (2.4.1)
- FIFA World Cup 2010 Disaster Management (1.7.6)  2010 priorities.
Driver deaths and alcohol
City comparisons 2004
100%
50%
0%
Johannesburg
Zero
0.01 – 0.04
Durban
0.05 – 0.14
Cape Town
0.15 – 0.24
Tshwane/Pretoria
>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 nonmotorised 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.
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