Lecture 32. Road traffic injuries. Flashcards
Who are more affected by the road traffic injuries?
Children > Adults
Men > Women
Pedestrian > Car occupants
Fatal > Non-fatal crashes
What is the distribution of injuries globally?
Road traffic injuries, Falls, Unintentional injuries and suicide are among the highest causes of injury.
Road traffic is the largest contributor to injuries worldwide
Patterns over time
All injury type rankings are increasing
Injuries are projected to make an increasingly
greater contribution to the global burden of disease over the next decades.
In NZ who are the most affected?
Vehicle drivers
Young people
Who are contributing the most to the DALYS in NZ?
Young men-> a lot of YLL and YLD
Men are more likely to die due to road traffic injuries across all vehicle types
What part of NZ is the most affected?
Auckland
Mostly in the age group 15-29 yo
What countries are the most affected globally?
Low-and-middle income countries
Although low and middle income countries have only half of the worlds vehicles they have 90% of the worlds road traffic injuries
What effect does high death statistics in Low and Middle income countries have?
People who die in road traffic injuries are in the working-age group and this leaves families without financial support-> drives poverty
Why are the statistics for road traffic injuries/deaths in the age group 70+ higher in high income countries?
Life expectancy is longer-> more 70 yo driving a car than in low income countries
Global burden distribution
- Higher burden amongst young people. 15-40
- Higher burden in low-income countries
- Men> women
Global trend
A downward trend in RTI in high-income countries
Upwards trend in RTI in low-income countries
How does the environment affect the risk for RTI?
- Inappropriate infrastructure, poor road design
- Lack of law enforcement
- Inappropriate regulations in place( helmet mandate, but not for children or bikers)
- Structural barriers force pedestrians to use the road( lack of crossings, footpaths)
How does the environment affect the risk for RTI?
- Inappropriate infrastructure, poor road design
- Lack of law enforcement
- Inappropriate regulations in place( helmet mandate, but not for children or bikers)
- Structural barriers force pedestrians to use the road( lack of crossings, footpaths)
How do RTI relate to the Haddon Matrix?
IMPORTANT: Injuries are not random events. These are largely predictable, and
therefore preventable.
Risk factors for injuries can be addressed on many levels
How do RTI relate to the Haddon Matrix?
IMPORTANT: Injuries are not random events. These are largely predictable, and
therefore preventable.
Risk factors for injuries can be addressed on many levels
Key Risk Factors to target for road safety efforts in low-middle income countries
- Speed
- Alcohol
- Seat belts and child restraints
- Helmets
- Visibility
why is it important to monitor the impact of intervention?
To monitor the effectiveness of the intervention as well as possible omissions and mistakes that can be fixed
Vulnerable road users
motorized 2-3 wheel riders
cyclists
pedestrians
how many riad traffic deaths are attributable to vulnerable road
> 50 %
how many countries have policies to protect vulnerable road users
<33%
Most policies are around the safety of cars
Distribution of road deaths by road user type
- Vulnerable road users’ deaths are high in South-East-Asia
- In the world-~same burden from Vulnerable road users as well as vehicles
RTI and socio-economic status and deprivation
injuries and deaths across all transport types are higher in more deprived areas
Inequity associated with RTI and deaths worldwide
in both HICs and LMICs disadvantaged socioeconomic groups (or those
living in poorer areas) are at the greatest risk of being killed or injured in a road
traffic crash
For example:
• RTI disproportionately affects less privileged children living in LMICs, where roads are the commonly shared places for playing, working, walking, cycling and driving.
• Sweden - Risk of injury for pedestrians and bicyclists was 20%-30% higher for children of manual workers than those higher-salaried.
Young people. children, men and vulnerable road users have higher risks
What determines the risk of injury?
• the distribution of resources and participation in society
• the legal and policy frameworks related to the road environment
(i.e., the upstream determinants)
Upstream determinant: distribution of resources and opportunities
distribution of resources and opportunities:
-Influences the choice of transport-cheaper but more dangerous options
-Limit the choice of where people can live→ Live in more hazardous environments
- Along highways, thus creating conflicts over space between the road users and the local population
- Poor road design – no crossing, no sidewalks
- Fewer speed restrictions
- No safe and accessible playgrounds → children using walkways and streets as play areas
- Compel children to be unaccompanied by a parent/adult when walking
-Limit access to health services consequent to accidents
→ Disproportionally affect SE deprived groups
→ Increased vulnerability to road traffic injury and mortality
Upstream determinant: Legal and policy frameworks related to road environment
- Vulnerable road users (pedestrians, two-wheeled vehicle users) are less protected • Public transport is often poorly funded and regulated
- Poor road designs are more likely in poorer neighborhoods
- Less marked crossing
- Less traffic calming measures
- Less sidewalks
- Higher posted speeds
→ Disproportionally affect SE deprived groups
→ Increased vulnerability to road traffic injury and mortality
How can RTI and Death can be addressed globally
-identify the upstream determinants
-Focus on environmental protection strategies instead of individual behavior
(Unless roads are safer educational interventions will not make a big difference)
-Need an epidemiological approach that goes beyond downstream causal factors
- determine exposure within the social context
- determine what shapes the risk for injury
- examine the relationship between injury and social status
Framework for Road Safety Strategy
Global Framework
- Road safety management
- Safer roads and mobility
- Safer vehicles
- Safer road users
- Post-crash response
Target: Half the number of deaths and injuries by 2030
WHO overarching recommendations
- Improve Daily Living Conditions
- Tackle the Inequitable Distribution of Power, Money, and Resources
- Measure and Understand the Problem and Assess the Impact of Action
Impact of global action
- Number of road traffic deaths continues to climb
- Although, the rate of death relative to population size has stabilized
Improvement in vehicle safety measures
Improvement in post-crash care
Increase in global attention, investments, and efforts (including political support)
Remaining Challenges:
- Increase political will
- Ensure accountability
- Strengthen data collection
- Build capacity in low resourced countries
- Improve vehicle safety measures
