Road injury prevention policy needed

by Prof. P. Hewage

Deaths related to road traffic are seen as a "disease of development". Unless effective measures are taken, the problem will get worse. Since a sizeable portion of the deaths and injuries affect vulnerable road users - pedestrians, cyclists and motorcyclists - the loss of life and damage of health at these people should be avoided.

Road traffic injuries are a global public health problem, killing about 1.2 million people a year and injuring between 20 and 50 million. Road traffic injuries are a major public health problem in Sri Lanka as well. The data released by the Police Department reveal that 2,179 people in Sri Lanka died as a result of traffic accidents in 2006. This represents an average of six persons dying each day from traffic accidents.

In addition to these deaths, 18,641 accidents have occurred in the same year, causing various levels of injuries to the people involved. The level of injuries include fatal, grievous and non-grievous. There were 14,698 damage only accidents reported in the same year. The deaths and fatal accidents indicate no sign of a decline despite a reduction in the total number of road accidents.

Global statistics confirm that road accidents have become one of the most prominent causes of death all over the world. According to the World Health Organization (WHO), road traffic deaths accounted for about two per cent of all global deaths and ranked as the leading "external cause" of all deaths for 2002. The external causes of death include suicide, violence, war, road traffic injuries, poisoning, falls, fires, drowning and other intentional injuries.

The road traffic deaths reported by the Department of Census and Statistics, Sri Lanka can be analyzed to identify comparable figures applicable to Sri Lanka. Road accident deaths accounted for about 1.8 per cent of all deaths in the island. Transport accidents are the second leading external cause of death in Sri Lanka.

In general, the comparative figures for Sri Lanka are lower than the corresponding global figures. However, when the trends in Sri Lanka's transport accidents are compared with the information for high-income countries, a different picture emerges. These observations illustrate the fact that Sri Lanka should be looking forward to ways of minimizing the burden of road traffic injuries.

The lower levels of road deaths in high-income countries are attributed, by the researchers, largely to the implementation of a wide range of road safety measures designed under an effective road injury prevention policy. These measures include seat-belt use, wearing helmet vehicle crash protection and traffic law enforcement.

Any reduction in the road traffic injuries may not necessarily mean an improvement in road safety for all people, mainly because vulnerable road users - pedestrians, cyclists and motorcyclists - have a higher risk of being involved in an accident. According to the Police Department, pedestrian fatalities comprise the largest proportion of all deaths due to transport accidents in Sri Lanka. The proportion of drivers killed is much lower than the fatalities among pedestrians and passengers.

The inappropriate diversity in vehicles and the heavy mix between the slow-moving and non-motorized road users and fast-moving, motorized vehicles may have placed pedestrians and cyclists at higher risk of being killed by accidents. In developed countries, however, where a larger number of motor vehicles are used, fewer motorcyclists, cyclists and pedestrians are killed in road accidents.

Road accidents place a heavy burden on the national economy as well as on the household economy. For example, traffic deaths are much higher among males than females, and if those males were employed, the loss of life or physical damage may have grave consequences on their family economy. The data released by the Department of Census and Statistics confirms that nearly 85 per cent of the people that died in road accidents in Sri Lanka are males. The gender difference in deaths may possibly be the result of both heavy exposure to road transport and the risk-taking behaviour of males. The data also indicate that though road travel brings the society many benefits, the price society has to pay for it is very high.

When compared with the data in developed and newly industrialized countries, Sri Lanka's per capita motor vehicle population is much below the expected level for a middle income country. Sri Lanka's motor vehicle population is 74 per 1,000 people; Australia, Japan and USA have more than 600 vehicles per 1,000 people. However, in Sri Lanka, the vehicle population has been on the increase in recent years, with the expansion of the economy and social needs. According to the Department of Motor Traffic, the number of vehicles has increased by 75 per cent during the seven-year period between 2001 and 2007.

Correlation

One of the main factors contributing to the increase in road crash injuries is the growing number of motor vehicles in use. Studies have pointed out that there is a correlation between motor vehicle growth and the number of road crashes. The sudden increase in the vehicle population may have placed an added burden on the entire system of road transport in Sri Lanka, causing more road accidents. During the period of 2001-2007, an increase was reported in the number of three wheelers (322%) and motor cycles (185%). This emphasizes the importance of planning for the needs of these vehicles and the people who use them. For instance, the use of helmets or seat-belts may not be possible for three-wheelers and therefore, other options need to be identified for the prevention of road traffic injuries, including such vehicles.

While the defeat of terrorism in the North and East as well as in other parts of the country has turned a new page in the socio-economic spheres, we should not neglect the possibility of increase in road traffic injuries in those areas as people are increasingly moving around in those areas. The case of reunification in Germany provides a good illustration of how changes in political and economic factors can influence crash injuries. In Germany, there was a surge in access to previously inaccessible areas. In the two years following reunification, between 1989 and 1991, there was a four-fold increase in death rates for passengers. The overall death rate in road crashes in this period nearly doubled.

In Sri Lanka, records show that traffic accidents have been the highest type of accidents during New Year celebrations. From December 30, 2008 to January 1, 2009, 779 persons have been involved in accidents and, of this total, 249 (32%) were traffic accidents. Furthermore, the number of traffic accidents during the New Year has increased from 212 in 2008 to 249 in 2009.

The development of a road injury prevention policy should involve a wide range of institutions and people representing a diverse range of interests. They should include government institutions, police, media, citizens, universities, schools and NGOs. Government intervention is crucial for securing road safety. There is evidence that the - strategies for reducing traffic injury are more effective under a specific government institution with the power and funding. A government institution responsible for road safety should be established with its specific functions.

For example, with the establishment of the Swedish Road Safety Office, the number of road deaths in Sweden declined each year during the period between 1970 and the mid-1980s.

Similarly, between 1995 and 2002, the city of Bogota, Colombia experienced a reduction in the number of traffic-related deaths by almost half with the implementation of a range of policies. The first was to set up a data reporting system on deaths from violence, and data traffic crashes. Using the an inter-agency committee produced a set of public policies aimed at reducing the number of accidents.

Political support

In addition to the establishment of an institution with the responsibility for road safety, strong political support is also essential to bring about a productive impact of the policy on prevention of road injuries.

An effective road safety policy can also be supported by the parliament. For example, a Parliamentary Committee was responsible for the introduction of breath-testing, leading to a considerable reduction in deaths in the State of New South Wales, Australia. In the state of Victoria, also in Australia, an action by a Parliamentary Committee had led to the world's first legislation on compulsory use of seat-belts. As a result, car occupant deaths had fallen considerably. It is important that the parliament should provide both power and funding to the relevant institutions to implement road safety measures.

Research capacity is another key issue of road safety. A strong policy on road traffic prevention should be supported by accident research. National level research can identify people at increased risk of road injury, major factors contributing to the road traffic injuries and their implications for policy formulation. There are many examples of the role of research carried out by universities and other research institutions in developing a policy on road accident prevention. Accident research units are established at universities mainly in the developed world such as Australia, England, USA and Germany. Non-governmental research institutions have also made significant contributions to traffic accident prevention in developed countries. The vehicle manufacturing industry, insurance industry and other related industries in the transport sector can make a valuable contribution to road safety by helping better designs and providing important information on safety. For example, Alcohol Ignition Interlocks have been introduced to discourage drunk driving.Non-governmental organizations can contribute to road safety by influencing the effective implementation of strategies and by providing a forum for information on solutions to road crashes. Mothers Against Drunk Driving in USA was a success story with mandatory prison sentences, and a minimum drinking age set at 21 years. In developing countries, the role of NGOs is not successful mainly due to lack of funding.

Traffic injury

While the formulation of a policy on road injury prevention is primarily the responsibility of the government, implementation can be done with productive participation between the private and public sector. Effective participation is possible in many areas of road injury prevention. The State of Victoria in Australia has developed a partnership between traffic law enforcement and traffic injury compensation schemes. In this scheme, victims of road crashes are compensated through a system in which the insurer pays for any damages incurred in a crash, regardless of which party was considered at fault. The funds are diverted for this purpose from annual vehicle registration charges. This strategy has successfully been implemented in South Africa.

A partnership between the government and motor vehicle importers can deliver important information to the customers about the performance of cars in realistic crash tests. In Australia, USA and EU, new cars are subjected to a range of crash tests and their performances are rated with a "star" system. Such programs help consumers realize the value of safety and take the information into account when they purchase new vehicles. Vehicle importers should respond by importing vehicles with improved designs.

"Vision Zero" is a traffic safety policy developed in Sweden based on four elements; ethics, shared responsibility, safety philosophy, and driving mechanisms for change. It is relevant to any country to create a sustainable road transport system. Its principles can be applied to any type of road transport system.

Shared responsibility - Responsibility is shared between the providers of the transport system and the road users. The road user is responsible for following basic rules, such as obeying speed limits and not taking alcohol while driving. If road users fail to follow the systems the responsibility falls on the providers to redesign the system.

Safety philosophy - Vision Zero has replaced the concept of "Road safety is the responsibility of the road user" by two premises: human beings make errors and survival and recovery from an injury has a limit. The road transport system should be able to take account of human failings and absorb errors in such a way as to avoid deaths and injuries. The chain of events that leads to deaths or injuries must be broken.

Driving mechanisms for change - To change the system, the first three elements should be involved in a policy. Vision Zero accepts the right of citizens to survive in a complex system. The demand for survival and health is the main driving force.

In Vision Zero, the providers of the road transport system are responsible to citizens and must guarantee their safety in the long term. At the same time, the road user has an obligation to comply with the basic rules of road safety. In Sweden, the measures undertaken includes a focus on vehicle crash protection, securing seat-belt use, installing crash-protective barriers on roads, encouraging authorities to implement 30km/h zones, use of speed cameras, random health tests and promotion of safety in road transport contracts.

Traffic injuries are a growing problem in our country and it is a public health issue which needs proper planning to minimize its devastating impact on society. The term "accident" can give the impression that "it is inevitable, unpredictable and unmanageable". The World Health Organisation and the World Bank argue that road deaths and injuries are unacceptable, and avoidable. Therefore, traffic accidents require meticulous efforts for prevention. There is also a need to recognise the current situation in road accidents and to take appropriate action.

As such, road traffic injury prevention should be given proper attention and resources for human loss and injury to be averted. A good example can be found from Japan where a downward trend of deaths due to traffic accidents has been seen during the last four decades.

The writer is attached to the Department of Geography, University of Kelaniya