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 (n=971)

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 (>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

9. Pedestrian deaths by age and alcohol (n=3475) Cape Town 1994-2003 Source: Matzopoulos 2005. Alcohol-related pedestrian fatalities in Cape Town, South Africa

10. 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

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 project’s other working groups use an ecological approach

12. 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 • 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

15. 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 - Biological

16. 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 - Behavioural

17. 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 Traffic - Societal

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.

24. Driver deaths and alcohol City comparisons 2004

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

26. 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.

27. 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