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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

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road traffic injuries

Road Traffic Injuries

Review of risk factors and interventions

background
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

background3
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.

background5
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.

background6
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
Road traffic mortality rates in Cape Town 2001 to 2004

Source: Matzopoulos 2005. Sixth annual report of the NIMSS

background8
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
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
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
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
Public health approach

Host

(injured person)

Environment

(social, physical)

Vector

(vehicle)

Agent

(kinetic energy)

the systems approach
The systems approach
  • factors influencing exposure to risk
  • factors influencing crash involvement
  • factors influencing crash severity
marrying the systems and ecological approaches
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

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 - Biological
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 - Behavioural
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

Traffic - Societal
traffic structural
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 structural19
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
Where to from here?
  • Alignment and prioritisation
  • Integration and monitoring
  • Evaluation and evidence
alignment
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
Four priority areas for BoD
  • Integrated incident reporting and management system
  • Drunk driving
  • Non-motorised transport
  • Road safety academy
incident reporting and management system
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.
drunk driving
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
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.
road safety academy
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