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Road traffic injury risk in a regional public health perspective. Stig H. Jorgensen Department of Geography, Norwegian University of Science and Technology (NTNU) NO-7491 Trondheim, Norway Paper for The Society for Risk Analysis – Europe conference:

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Road traffic injury risk in a regional public health perspective l.jpg

Road traffic injury risk in a regional public health perspective

Stig H. Jorgensen

Department of Geography,

Norwegian University of Science and Technology (NTNU)

NO-7491 Trondheim, Norway

Paper for The Society for Risk Analysis – Europe conference:

Innovation and Technical Progress: Benefit without Risk?

Ljubljana 11 – 13 September, 2006


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Overview

  • Discuss effects of a massive strategy for road safety and risk minimizing (Vision Zero)

  • Present geographical and structural trends for private motor vehicle crashes, Norway 1998 – 2004.

  • The scopes for following up strategies on road safety and health promotion in a regional perspective

  • Conclusions.


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The Vision Zero strategy

  • Carried out year 2000.

  • Focus: seriously injured and killed road users.

    (Zero fatal traffic injuries year 2030?)

  • A system risk perspective:

    the interplay of road users and vehicles in the road system.

  • A contract between:

    road authorities (system designers) and individuals (road users).


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Background: road safety and public health

  • A new paradigm (and demand?) for road traffic in public health.

  • Basic principles founded in ethics and equity.

    (cf. ’innocent’ victims in crashes, the value of a life lost in traffic)

  • Unnecessary and avoidable health risks (?)

  • Public health trade off for other (transport) benefits.

    (accessibility, regional competition and attractiveness)

  • Smoothing out structural (system) inequalities in public health risk. (pollution; food and water quality etc.)

  • System functions versus individual responsibility and risk taking.


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Implications of risk minimization

  • Unrealistic (system risk, human unfallibility)

  • Individualism (freedom, coping capacity) vs standardisation

  • The possibility for injuring other (’innocent’) road users

    Risk minimization versus risk optimization

  • ” Zero risk” urges perfectionism

  • ”Healthism”, tolerance for deviation

  • Territorial justice is difficult to achieve


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Possibilities for implementing efficient safety measures

Physical environment, land use and transportation modes

  • Road network investments

  • Traffic calming schemes

    Enforcement and controls (depriving of freedom)

  • Police enforcement, speed cameras

    Drivers attitudes and risk-taking behaviour

  • Education, training, campaigns

  • Public consciousness, publicity

  • Diffusion of safety behavioural changes (safety culture)

    Vehicle safety devices and technology

  • Alcohol interlocks,

  • Intelligent speed limiters


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Safety priorities favouring urbanised areas ?

Intended effects:

  • The per capita principle and road safety investments

  • Concentrated in areas with the highest absolute no. of fatalities

  • Supported by cost-effectiveness/cost-benefit assessments

  • Preferences for population strategies towards low-risk groups

    Non-intended effects:

  • Concentrated efforts in high traffic volume areas:

     a systematic geographical difference in the relative risk level.

  • A redistribution, with a higher risk level in the rural areas ?

    More risk prone rural population?


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Traffic accident data

  • Police-recorded road traffic accidents 1998-2004.

    (Norwegian Public Roads Administration)

  • Selection: motorized road users, private 4-wheel automobiles:

    killed and seriously injured (N= 5233)

  • Population based approach: the casualty’s place of residence

  • - Degree of coverage for residential municipality (1999-2004)

  • - for the whole country: 84.8 % (N = 4247 out of 5008)

  • Specific missing percentages for:

    adequate protection: 39%

    alcohol suspicion: 1%

  • Possible systematic bias: underreporting in rural municipalities


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Grouping of municipalities into area types

Classification by:

  • Population density (percentages in densely populated areas)

  • Size of settlement (< 5 000, 5 0000-14 999, > 15 000)


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Fig. 1 Map of Norwegian municipalities displayed by an

rural-urban gradient 1998 - 2004


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Fig. 2 Number of killed and seriously injured people, in private 4-wheel motor vehicles, by sparsely/densely populated area and type of place of accident. Norway 1999 – 2004.


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Fig. 3 Percentage of killed and seriously injured people, in private 4-wheel motor vehicles, by sparsely/densely populated area and type of place of accident. Norway 1998 – 2004.


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Fig. 4 Killed and seriously injured people, in private 4-wheel motor vehicles. Rate per 100, 000 population (sex and age adjusted) by sparsely/densely populated area and type of place of residence. Norway 2004

(N rural = 299) (N periurban= 171) (N urban = 234)


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Fig. 5 Percentage of killed and seriously injured people, in private 4-wheel motor vehicles, by type of place of residence. Norway 1999 – 2004.

(N 6 years = 1709)

(N 6 years = 994)

(N 6 years = 1537)


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Fig. 6 Percentage killed and seriously injured people not using seatbelts, in private 4-wheel motor vehicles by type of place of residence. Norway 1998 - 2004.

(N 7 years = 352)

(N 7 years = 167)

(N 7 years = 158)


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Fig. 7 Percentage killed and seriously injured people with suspicion of alcohol alcohol in private 4-wheel motor vehicles by type of place of residence. Norway 1998 - 2004.

(N 6 years = 292)

(N 6 years = 128)

(N 6 years = 255)


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Fig. 8 Percentage killed and seriously injured males involved in risk taking driving (non-usage of seatbelt or alcohol or running off the road) 4-wheel motor vehicles by age and type of place of residence. Norway 1999-2004.


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Table 3. Road traffic injury rates (for 7 years), killed and serious injured 4 wheel motorised road users per 1000 population, by type of residential municipality (education). Norway 1998-2004.


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Goal and intrests conflicts

The traffic system vs. the health system

  • Local health safety versus to consolidate settlements

  • Market failures and negative external effects in the road transport system

  • Health risks are often considered as long time accummulated risks (smoking, diet habits)


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Geographical redistribution of risk

  • Structural inequality (in specific geographical environments)

  • Non-intended results of efficiency and accessability

  • Territotial equity and uneven development in health policy

  • Neo-liberalism winds

    (favouring market competition solutions, and distributions)

  • Compensation mechanisms ?


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Strategies

  • ”Standardisation” of human (driving) activities

  • Technical control of risk minimizing behaviour

  • Widespread surveillance and control system


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Risk minimising strategies

Balancing urban-rural efficiency, equality and equity

  • Compensation, positive discrimination in road improvements

  • Implementation of non-human control systems

  • Tailor made behavioural campaigns (local engagement)


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Conclusions

  • Killed and seriously injured automobile occupants are concentrated in sparsely populated areas.

  • Disparities urban - rural areas are not increasing over time.

    Effects of “Vision Zero” regarding road users place of residence:

  • Rural people face a higher serious accident rate.

  • A geographical redistribution of crash risk in disfavour of sparsely populated areas,

    not in disfavour of rural areas in general.

  • No tendencies to absolute reductions or redistribution of casualties related to driving violation


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  • A public health goal of risk minimization

    seems less feasible in rural and sparsely populated areas

    for various geographical and structural reasons.

  • Stronger, and more controversal, countermeasures have to be implemented in rural areas

  • The effects have to be monitored for a longer time span.


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