Lecture 32. Road traffic injuries.

Question 1

Who are more affected by the road traffic injuries?

Answer 1

Children > Adults
Men > Women
Pedestrian > Car occupants
Fatal > Non-fatal crashes

Question 2

What is the distribution of injuries globally?

Answer 2

Road traffic injuries, Falls, Unintentional injuries and suicide are among the highest causes of injury.
Road traffic is the largest contributor to injuries worldwide

Question 3

Patterns over time

Answer 3

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.

Question 4

In NZ who are the most affected?

Answer 4

Vehicle drivers
Young people

Question 5

Who are contributing the most to the DALYS in NZ?

Answer 5

Young men-> a lot of YLL and YLD
Men are more likely to die due to road traffic injuries across all vehicle types

Question 6

What part of NZ is the most affected?

Answer 6

Auckland
Mostly in the age group 15-29 yo

Question 7

What countries are the most affected globally?

Answer 7

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

Question 8

What effect does high death statistics in Low and Middle income countries have?

Answer 8

People who die in road traffic injuries are in the working-age group and this leaves families without financial support-> drives poverty

Question 9

Why are the statistics for road traffic injuries/deaths in the age group 70+ higher in high income countries?

Answer 9

Life expectancy is longer-> more 70 yo driving a car than in low income countries

Question 10

Global burden distribution

Answer 10

• Higher burden amongst young people. 15-40
• Higher burden in low-income countries
• Men> women

Question 11

Global trend

Answer 11

A downward trend in RTI in high-income countries
Upwards trend in RTI in low-income countries

Question 12

How does the environment affect the risk for RTI?

Answer 12

• 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)

Question 13

How does the environment affect the risk for RTI?

Answer 13

• 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)

Question 14

How do RTI relate to the Haddon Matrix?

Answer 14

IMPORTANT: Injuries are not random events. These are largely predictable, and
therefore preventable.

Risk factors for injuries can be addressed on many levels

Question 14

How do RTI relate to the Haddon Matrix?

Answer 14

IMPORTANT: Injuries are not random events. These are largely predictable, and
therefore preventable.

Risk factors for injuries can be addressed on many levels

Question 15

Key Risk Factors to target for road safety efforts in low-middle income countries

Answer 15

• Speed
• Alcohol
• Seat belts and child restraints
• Helmets
• Visibility

Question 16

why is it important to monitor the impact of intervention?

Answer 16

To monitor the effectiveness of the intervention as well as possible omissions and mistakes that can be fixed

Question 17

Vulnerable road users

Answer 17

motorized 2-3 wheel riders
cyclists
pedestrians

Question 18

how many riad traffic deaths are attributable to vulnerable road

Answer 18

> 50 %

Question 19

how many countries have policies to protect vulnerable road users

Answer 19

<33%

Most policies are around the safety of cars

Question 20

Distribution of road deaths by road user type

Answer 20

• Vulnerable road users’ deaths are high in South-East-Asia
• In the world-~same burden from Vulnerable road users as well as vehicles

Question 21

RTI and socio-economic status and deprivation

Answer 21

injuries and deaths across all transport types are higher in more deprived areas

Question 22

Inequity associated with RTI and deaths worldwide

Answer 22

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

Question 23

What determines the risk of injury?

Answer 23

• the distribution of resources and participation in society
• the legal and policy frameworks related to the road environment
(i.e., the upstream determinants)

Question 24

Upstream determinant: distribution of resources and opportunities

Answer 24

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

Question 25

Upstream determinant: Legal and policy frameworks related to road environment

Answer 25

• 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

Question 26

How can RTI and Death can be addressed globally

Answer 26

-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

Question 27

Framework for Road Safety Strategy

Answer 27

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

Question 28

WHO overarching recommendations

Answer 28

1. Improve Daily Living Conditions
2. Tackle the Inequitable Distribution of Power, Money, and Resources
3. Measure and Understand the Problem and Assess the Impact of Action

Question 29

Impact of global action

Answer 29

• 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)

Question 30

Remaining Challenges:

Answer 30

• Increase political will
• Ensure accountability
• Strengthen data collection
• Build capacity in low resourced countries
• Improve vehicle safety measures