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Indian Journal of Community Medicine

Road Traffic Injury Prevention: A Public Health Challenge

Author(s): Jagnoor

Vol. 31, No. 3 (2006-07 - 2006-09)

After the first road fatality on 17th August 1896 in London, the Coroner said, “This must never happen again”.1 More than a century later, globally, 1.2 million people die each year on roads.

Industrialization leads to economic growth, further leading to increased mobilization of people, increased investment on automobiles and road infrastructure. Therefore, effective transportation supports a nation’s economic and social growth. Most of the developing countries like India are at a transition phase of growth and development2. India has one of the largest highway and road network second only to road network of U.S. Total road length exceeds 3 million3; and it has about one percent of world’s vehicle population, but six percent of the world’s road accidents occur in India4.

Air and noise pollution are some visible effects on the roads, but a deeper underlying problem of injuries and death on the roads goes unaccounted and neglected. Over 80,000 people die in the traffic crashes annually, 1.2 million are seriously injured and about 300000 disabled permanently5. In India, among individuals more than 4 years of age, more life years are lost due to traffic crashes than due to cardiovascular diseases or neoplasms6.

Hospitals, medical centers and institutions, police records, insurance data, special surveys/epidemiological studies and vehicle operators are some of the sources for data, used worldwide in regards to road traffic injuries and mortality7. Many studies conducted in various parts of the country, and records from concerned departments, show huge discrepancies in the data5,8,9. A conservative estimate of 1:15:70 has been made for ratios between deaths, injuries requiring hospital treatment, and minor injuries.

Pedestrians, bicyclists and motorized two wheelers have been identified as the most vulnerable group constituting 60-80% of road fatalities in India. Two wheelers, motorized (70%) and non-motorized (10-35%) vehicles are the main component of Indian traffic. Less than 1 in 40 families own a car5. It has also been observed that fatal crashes with pedestrians, bicyclists and motorized two-wheelers involved buses and trucks in higher proportion (50- 70%) than non fatal crashes2. Occupants of two wheelers and occupants of public and private transport is another group of people constituting the majority, to be affected in road traffic injuries10. On highways, occupants of cars are the most vulnerable group, next to pedestrians5.

Various studies in different parts of the country found that highest numbers of road crash victims were between the ages of 20-40 years2,5,11. A study conducted in Pondicherry, shows that males causalities (83%) were far more than female causalities (17%) on roads. The same study also found that victims with higher education (matriculation or above) were fewer in proportion2. People from lower income groups are further identified as high-risk category5.

All India road data shows that 83.5% of the accidents were due to driver’s fault, other contributory factors were: mechanical defects in vehicles (3%), pedestrian fault (2.3%), fault of passenger (2.4%), bad roads (1.1%), bad weather (0.9%) and other factors like cattle, fallen trees etc. (6%)12. Statistics of 83.5% accidents resulting from drivers fault indicates the need of an intensive intervention at host level.

A study in Bangalore showed that 44% of crash two wheelers drivers, seeking medical treatment were under the influence of alcoho15. Data at national level is not available, but drink driving apparently is a big issue. A study conducted on brain injuries also revealed that, there were higher rate of falls and severity of brain injury was also more, amongst drivers under the influence of alcohol13. There is a need for stringent laws and their enforcement to restrain drink driving. Public awareness regarding hazards of drinking and driving should be increased through mass media and educational campaigns.

Perhaps, drivers fault can also be attributed to system of issuing license. License is issued to anyone who is above 18 years, can identify a few road signs. The licensing officer would rarely stand by the road and watch you drive for 500 meter, leading to unskilled and ignorant drivers on roads. Making learners license mandatory, with specific guidelines, better system for testing driving skills, and curtailing under age drivers through law enforcement are some of the steps that might prove to be of help2,5. In most parts of the country, but not all, male drivers are enforced to wear helmets2 and a few years ago a law for passengers was also introduced, but none of it is implied to females (drivers/passengers) or child passengers.

Motorized and non-motorized vehicles and pedestrians share same road space. An evidence of conflict between the motorized and non motorized vehicles is evident from New Delhi data according to which, 40% of fatal bicycle crashes occur during peak hours when speed is low (20-30 km/hr) but volumes are significantly high. This is not the situation only on city roads, but on all roads, including highways, where heavy motorized vehicles and bullock carts share the same space5.

Though there is no data available on accidents and fatalities related to two wheeler vehicles and animal collision, but local newspapers have news of such accidents on almost a weekly basis. People and authorities seem to be aware of the situation, but it appears that there is an ongoing blame shifting from one department to another. Little has been done to improve the situation. There is a need of co-coordinated effort to attain a solution.

Indian Road Congress issues guidelines and standards for all Indian roads and highways. These standards are recommendatory and not mandatory. There is no authority to view whether or not these recommendations are being followed. Recognizing the issues due to mixed traffic and its growth, there is a need to initiate evidence-based changes in Indian road designing. Also there is need for some regulatory changes in order to improvise a body, which is responsible for implementation of road design standards5.

As mentioned above, mechanical faults contributed to 3% of accidents, conditions of vehicle need to be checked on regular basis. There is no law regarding smooth tyres, and brake conditions etc. A system for regular check of vehicle condition, might improve vehicle and road safety. An added advantage would be air pollution check.

Though there is no law for rear passengers to wear seat belt, but except for a few very expensive models, vehicles do not even have the facility of rear passenger seat belts. Most vehicles lack features like high mounted rear brake lights, air bags, rear wipers etc5. Understanding the relevance of these features, contribution from engineering and manufacturing companies is required to bring about changes for improved vehicle safety.

Pedestrians constitute one of the most vulnerable groups for road traffic injuries. In minds of Indian road users there is no place for pedestrians on roads4; one would observe that, zebra crossings are made on very few roads in the country, and those, which exist, are not used by the pedestrians or the rules are not followed by the traffic. Also, subways built in few cities are homes for beggars than pathways for pedestrians. Though all vehicles share the same road space, there are no laws or regulations for using roads or safety guidelines for bicyclists, rickshaw pullers and other non-motorized vehicles5.

No comprehensive data is available to how many children die or are injured on their trip to school. Observing children popping out of various kinds of vehicles at a school gate and going through newspapers can fairly provide an idea of how unsafe trips to schools are; a rickshaw with a passenger capacity of no more than 3 would be loaded with 10 -14 children, bus with a capacity of 54 passenger would be carrying 100-150 children, with bus driver as the sole care taker. After series of deaths of school children in New Delhi, admissions in schools were restricted by area of residence14. Regular maintenance of school buses is presently an issue of debate in the city. This is the only progress in the capital city of the nation; issue in the nation is yet to be addressed. It is very difficult to assess the economic cost of road crashes. In Indian society death or disability of one family member would affect education and career opportunities for all the family members. Scarcity of rehabilitation facilities, lack of welfare functions and aids further deteriorates any employment opportunity for the disabled and increases the investment of time and money by the family members of the victim15.

In a developing country like India, public health facilities are scarce. Only 0.9% of GDP is spent on public medical services16. Ambulance or a first aid team attends hardly any accident victim. On the contrary public hires a transport for the victims to hospitals, and many a time even that is avoided due to legalities involved3,5. There is a need for an affordable, effective and sustainable intervention for post crash trauma care.

Preventing road crashes and the injuries is the most important area that calls for attention of the policy makers, as it is not only important for health, social and transportation perspective, but is also cost effective. According to estimates of 1995, 3.2% of GDP is the estimated cost of road traffic injuries, in India5. In 1884, Louis Pasteur told his students that “when meditating over a disease, I never think of finding a remedy for it but, instead, a means of preventing it”17. Perhaps, prevention of these road incidents is the best path, but before radical steps can be taken, a lot of research is required to be done.

In the wake of above discussed issues, it is important to implement strategic interventions. No intervention can be successful in the absence of effective and accurate surveillance system, and hence is the primary need. Unavailability of reliable data sources in India indicates that foundation for road safety is yet to be laid in this country. Interventions based on vague data cannot succeed. Hence primarily intervention is required in data collection and analysis.

This would involve a collaborative effort by all the sectors involved. Police data collection needs to be more defined and extensive. For the road safety professional database should be able to provide information about location (coordinate maps, km post etc), detailed timing, people involved and injured in relation to vehicle age, sex; vehicles, animals and road side objects. Resultant crash injuries and property damage are also relevant. It’s also important to consider environmental conditions like weather, road surface condition, and light etc7. Hospitals and all other medical institutions need to establish traffic injuries surveillance system in accordance with WHO guidelines. Further collaborated efforts by various institutions of engineering, medicine, law etc are needed to conduct research and train teams to collect coordinated data7,18.

Also there is need for institutional changes, which would involve aspects of road engineering, hospitalization, academic changes-vocational training specific to each safety issues. Safer roads and vehicles need to be developed and maintained. At least, personnel’s involved in public transportation must be given training in first aid skills5,11. Public support is of utmost relevance, as it is primarily an issue of changing attitudes. Special campaigns should be organized, especially involving young drivers. Regulatory changes and law enforcement are another critical aspect.

Even the existing laws fail to be enforced due to inadequate, inefficient and corrupt system. Tragedies on road often do not catch media attention; they are only, a part of local newspaper. There is a need for all members of the society to understand the relevance of road safety including media, policy makers and all road users5.

Strategic changes in the existing system would help evolve a better system for future. Sustained, collaborative and concentrated efforts are required. Else, the once considered blessing of technology which has become a necessity today will become an abuse and may lead to unbearable human loss in terms of burden of disability and death due to road traffic crash.


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