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Motorcycle helmet wearing in Viet Nam ..... is the job done?

Jonathon Passmore Technical Officer, Road Safety and Injury Prevention, WHO Viet Nam


This presentation UPDATE • • • • •

Overview – road traffic injuries in Viet Nam Motorisation in Viet Nam Prevalence of major risk factors Road safety enforcement WHO support to road safety in Viet Nam


RTI as leading cause of death

Source : VINE Project 2008


Source : WHO GBD 2004


Disability Adjusted Life Years (DALYs)

Source : VINE Project 2008


Years of Life Lost (YLL)

Source : VINE Project 2008


Road safety management

PRIME MINISTER DEPUTY PRIME MINISTER Minister of Transport

Vice Minister Public Security

National Traffic Safety Committee 63 Provincial TSC’s

Secretariat National Mass Organisations Public private partners International Organizations

Standing Office


Road trauma in Viet Nam NTSC/MPS

MOH

Road traffic deaths (2009)

11,094

15,012

Road traffic injuries (2010)

10,306

435,181

12.9/100K

17.4/100K

Mortality rate 35,000

30,000

# of road crashes

Deaths

Injured

25,000

20,000

15,000

10,000

5,000

0 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010


Road traffic injury mortality by province, 2008 • Large variation in mortality rates • Anecdotally associated with major transport hubs (national/international roads)

30+ 20-29 10-19 0-9


Motorization in Viet Nam • 33.2 million vehicles in Viet Nam (2010) – 95% motorcycles – > 8,000 new motorcycles per day – > 500 new cars per day

35,000,000 30,000,000

Motorcycles

Cars, Buses, Trucks

25,000,000 20,000,000 15,000,000 10,000,000

5,000,000 0 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010


History of helmet legislation in Viet Nam

1997 NTSC formed

1995 Decree 36

2001 TCVN helmet standards for adults & children RS Law MOT Circ Decree 39 (penalty)

1998-2000 TCVN helmet standards for adults & children RS Law

2007 Resolution 32 Mandatory helmet wearing

2008 QCVN standards revised Single standard covering adults & children

2010 Decree 34 (penalties) Wearing for children

2009 Revised RS law Helmet wearing full law Fastening


National helmet law

Pre law

Post law 15 December 2007: Helmet Law + Enforcement + Education


What contributed to the success this time? •

Political support

Demonstrated effectiveness of helmets

Implemented in effective manner

– Highest level (Prime Ministers Office & the Party) – Whole of Government approach (NTSC coordinated)

– Confidence a helmet law could be successful if implemented correctly

– Strict penalties (10 fold increase) – Advance social marketing and public education – Civil service role models • 4 million citizens, plus members of the armed forces – Stringent and consistent enforcement • high perception of being caught – Reduced confusion of coverage • all roads, all times, all riders and passengers – Availability of affordable, climatically appropriate helmets


Roles for individual members of NTSC Ministry of Transport Coordinated development of legislation; instructing other members of the NTSC, and the 63 PTSC on implementation of the law Ministry of Public Security nationwide instruction to all police to ensure that enforcement was thoroughly implemented Ministry of Health hospital based surveillance system for road traffic injuries Ministry of Education and Training School based education on the benefits of helmet wearing Ministry of Communication and Information Delivery of mass media social marketing campaign through official channels including daily road safety programming on national TV


Social marketing • •

NTSC commenced SM campaigns in 1998 In 2007, partnerships with AIPF commenced targeted campaigns –

TV, Cinema, Posters, Billboards, bus shelters etc


Social marketing


Social marketing


Social marketing


Enforcement for road safety •

10 fold increase in penalties for not wearing helmet – from 20-40K VND (≈USD 1-2) (2005) to 100-200K VND (≈USD 612) per offence

Total traffic infringements 5,431,191 – 682,789 (13%) for not wearing helmets – No reliable data available for 2007

Ongoing challenge – Human resources – Maintaining the high levels of enforcement necessary


Infringements – All infringements vs helmets only 7,000,000 Total infringements

Helmet wearing violations

6,362,907

6,000,000 5,589,635

5,431,191

infringements

5,000,000

4,000,000

3,000,000

2,000,000

940,601

1,000,000

682,789

526,510

0 2008

2009

2010


Motorcycle helmet wearing –long term trend

120

Riders

99.5 97.5

100

99.0

98.0

99.0

Passengers

98.9 96.4 94.3

91.6

91.0 88.1

86.8

85.4 80.2

80

81.9

90.6

96.0

97.9 94.6

87.6

86.8

93.9

90.3 87.6

84.6

80.7 75.2

72.9

72.8

65.2 62.5

60 50.7 47.9 42.1

40

27.5 21.7

20

0 Nov-07

Jun-08

Dec-08

May-09

Yen Bai

Sep-09

Feb-11

Nov-07

Jun-08

Dec-08

May-09

Da Nang

Sep-09

Feb-11

Nov-07

Jun-08

Dec-08

May-09

Binh Duong

Sep-09

Feb-11


Motorcycle helmet wearing –long term trend • Helmet wearing has increased substantial since the 2007 helmet law and high wearing rates have been maintained since

BUT

• Issues of low helmet quality and not wearing helmets correctly have the potential to seriously impact the injury prevention potential of this legislation and the fact that the majority of motorcycle riders and passengers are wearing helmets


Wearing rates in Hanoi


Pre/post law impact •

Very limited information on impact of helmet law

Data on all road users, no breakdown for MC riders and passengers only

Deaths

Serious injuries

2008 vs 2007 – 1,557 ↓ death – 2,495 ↓ serious injuries

2007

12,800

11,097

2008

11,243

7,771

2009

11,094

7,559

2009 vs 2008 – 149↓ death – 212 ↓ serious injury

2010

11,029

10,306

2011*

8,903

8,055 * Jan-Oct

2010 vs 2009 – 65↓ death – 2747 ↑ serious injury


Pre/post law impact – Health data • National injury surveillance system in operation • Commenced 2008 • No pre law data 2008 Road traffic injuries % of RTI with head injuries

Declining reporting since • 2008 - 92/100 hospitals • 2009 – 84/100 hospitals • 2010 - 43/100 hospitals

2009

2010

183,058 143,940 117,317 27.1%

25.3%

17.8%


Hospital records - Head injuries 25,000 Road traffic injuries Road traffic head injuries 20,925 20,000 20,130

19,881

19,280

19,501

17,940

17,813

15,000

10,000 7,372

8,084

7,329

7,326 6,639

7,298

5,399

5,000

2004

2005

2006

2007

2008

2009

2010


Pre/post law impact – Health data % change

RR

95% CI

2007 vs 2008

-1.04%

0.98*

0.97-0.99

2007 vs 2010

-5.82%

0.88*

0.87-0.89

2007 vs 2008

-3.16%

0.95*

0.94-0.96

2007 vs 2010

-1.68%

0.89*

0.87-0.91

RT patients with head injuries 2007 vs 2008

-0.64%

0.98

0.96-1.01

2007 vs 2010

-7.69%

0.78*

0.76-0.81

2007 vs 2008

-0.16%

0.76*

0.59-0.99

2007 vs 2010

0.32%

1.25

0.99-1.56

All injuries Road traffic injuries

RT fatalities

* P<0.05

• Limitations of aggregate data • •

No breakdown by age and sex No breakdown by road user type (cant identify MC riders and passengers as a proportion of head injuries)


Helmet legislation loopholes •

Low wearing rate among children <16 years •

39%, 2008 (AIPF)

30%, May 2010 (HSPH & WHO)

21% December 2010 (HSPH & WHO)

Many parents believe helmets are dangerous for children

Adults can now be penalised however negligible enforcement

Incorrect helmet wearing •

Dec 15 law contained no ability to enforce unfastened helmets

Revised Nov 13 2008, police define un-fastened as unworn

Low quality helmet •

Only 20% meeting standard (VINASTAS)

Surveys in major cities estimate 30% & 45% meeting standards

High use of banned “cap” style helmets

New standards Nov 15 2008


Helmet wearing in primary school aged children Correct

Incorrect

No helmet

100.0% 90.0% 80.0% 70.0% 60.0% 50.0% 40.0% 30.0% 20.0% 10.0% 0.0% 2009

2010

Yen Bai

2009

2010

Hanoi

2009

2010

Da Nang

2009

2010

Can Tho


Helmet wearing in secondary school aged children


Child helmet wearing February 2011 (weekday)


Child helmet wearing, February 2011 (weekend)


Current follow up â&#x20AC;˘ Atlantic Philanthropies funding AIPF & NTSC to implement a national social marketing program in 2011 â&#x20AC;˘ Through grant from AP, WHO are complement public education program with enhanced enforcement program with police


Quality of standard helmets â&#x20AC;˘ Road side surveys show that high rates of helmet wearing are being maintained but the proportion of those wearing low quality non-standard helmets continues to grow

Latest results from June 2011 Ha Nam

Ninh Binh

Bac Giang

Wearing (%) Motorcycle riders

83.8%

82.3%

91%

Wearing (%) Motorcycle passengers

73.4%

77.7%

85%

BUT % of riders wearing non- standard helmets

46.4%

11.5%

30.6%

% of passengers wearing nonstandard helmets

50.2%

15.1%

40.2%


Quality of standard helmets


Some helmets are better than others!


Helmet standards - Tropical vs ECE 22 QCVN2: 2008 High degree of impact protection • Accepted, affordable, climatically appropriate to conditions in Viet Nam •

ECE 22 Higher degree of impact protection • ≈USD 30 • Not affordable in Viet Nam or relevant to climatic conditions •


Helmet standards - Tropical vs ECE 22 QCVN2

TCVN

ECE 22

Drop tower system

Monorail

Monorail

Free motion

Drop height

1500mm

1830mm (flat anvil), 1385mm (hemisp herical)

7.5 m/s onto flat/kerbstone anvil,

Maximum acceleration

< 225g (<300 circ < 500mm)

<300g

< 275 g


How does a helmet protect the brain?


How does a helmet protect the brain?


How does a helmet protect the brain?


What's coming? • Late 2011 – Viet Nam National Injury Survey – Helmet quality survey

• 2012 – Retrospective (2006-2011) records study of head injuries in major hospitals nationwide


Acknowledgements • National Traffic Safety Committee (NTSC) and all Government agencies responsible for the development and implementation of the helmet legislation • Hanoi School of Public Health (data collection) • Asia Injury Prevention Foundation (social marketing materials)


References • Pervin A, Passmore J, Sidik M, McKinley T, Nguyen THT, Nguyen PN. Viet Nam's mandatory motorcycle helmet law and its impact on children. Bull World Health Organ 2009;87:369-73. • Passmore J, Nguyen THT, Luong MA, Nguyen DC, Nguyen PN. Impact of mandatory motorcycle helmet wearing legislation on head injuries in Viet Nam: results of a preliminary analysis. Traffic Inj Prev 2010;11:206-2010 • Passmore J, Nguyen LH, Nguyen NP & Olivé J. The formulation and implementation of a national helmet law: a case study from Viet Nam. Bull World Health Organ 2010;88:783-787. Copies available


THANK YOU

passmorej@wpro.who.int

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