Public Health Approach to Australias Road Traffic Injuries - Coursework Example

Public Health Approach to Australia’s Road Traffic Injuries Student’s Name Institutional Affiliation Public Health Approach to Australia’s Road Traffic Injuries Road traffic injuries (RTIs) can be defined as a form of trauma that occurs rapidly instigated by use of road transport services (Bureau of Infrastructure, Transport and Regional Economic [BITRE], 2013). Although RTIs are not as common in Australia as in other nations, the reported rates of hospitalization and fatalities as a result of RTIs has a significant impact on the quality of life of Australians. Prevention of RTI is a primary public health method of reducing the number of RTI and the consequent hospitalization and mortalities (Christoffel & Gallagher, 2006). In this report, the four-step public health approach will be used to examine the size, risk factors of RTIs and evaluate possible preventive measures in Australia. Effective prevention methods, based on the three Es shall be considered for implementation to ensure that the number of reported RTIs significantly reduces in addition to hospitalization and fatalities related to RTIs. Size of the Problem RTIs have decreased dramatically since the late 20th century but in recent years the decline rate has been slow and sometimes even increases in RTIs have been observed in some years (Pointer, 2013). It is estimated that in 2010-2011, there were about 52 989 cases of reported hospitalization due to RTIs (Pointer, 2013). More males than females were affected with the age-standardized rates been higher in males compared to females. RTI age-standardized rates were higher in remote areas than in major cities suggesting that the rates increase with increasing remoteness (Pointer, 2013). The age-standardized rate for every 100000 people was estimated to be 451, 458, 335, 296 and 200 in very remote, remote, outer regional, inner regional and major cities respectively (Pointer, 2013). However, the number of cases reported were more in major cities and inner regional areas compared to very remote and remote areas. About 1751 hospitalization cases of RTIs affecting indigenous people were reported in 2010-2011 (Pointer, 2013). More males were hospitalized compared to females (Henly & Harrison, 2013). However, compared to the rest of the Australian population, injury among the Indigenous population was only 9% compared to Australia's 12%. Nevertheless, the age-standardised rates for RTIs are higher for both males and females from the Indigenous community compared to the whole Australian population (Pointer, 2013; Henly & Harrison, 2013). Generally, according to Henly & Harrison (2013), age-standardised rates of RTI reveal that the likelihood of an Indigenous individual getting fatally injured as an occupant of a car was three times that of other Australians and they are five times more likely to be fatally involved in RTIs as pedestrians compared to other Australians (Henly & Harrison, 2013). The various groups implicated in RTIs include pedestrians, pedal cyclists, motorcyclist, car, bus, van, heavy transport vehicle and three-wheeled motor vehicle occupants. In 2010-2011, car occupants comprised 36% of individuals hospitalized as a result of land transport injuries. Motorcyclist, pedal cyclists and pedestrians comprised 28%, 18% and 8% of RTIs-related hospitalization (Pointer, 2013). The eight Australian States experience varied rates of RTIs related injuries and hospitalization. For instance, in 2009-2010 New South Wales (NSW) experienced the highest number of fatal crashes followed by Victoria (Australian Bureau of Statistics [ABS], 2012). The number of individuals who succumbed to the RTIs was also highest in NSW. However, the rates per 100000 people were highest in Northern Territory (13.71) followed by Tasmania (12.52) and lowest in Australian Capital Territory (3.4) (ABS, 2012). The time of day and prescribed speed limit zones at which RTIs occur also vary. According to BITRE (2013), fatal RTIs occur between 6am and 6pm while about 37% are experienced at night from 6pm to 6am. Approximately 41% of RTIs happen over the weekend with weekend been defined as beginning from Friday 6pm to Monday 6am (BITRE, 2013). Considering that there are only two days in a weekend compared to five week days, it can be inferred that on average, a weekend day has more RTIs cases compared to a week day. Regions, where the speed limit is more than 90 km/h, account for most of the reported RTIs at an average of 45% over the first decade of the 21st century (BITRE, 2013). Regions where the limit is less than 60km/hr had about 32% of accident occurring there while regions with speed zones between 90 and 70 km/hr account for about 23% of the total reported RTIs (BITRE, 2013). Trends over Time The number of reported cases of RTIs has been rising since the year 2000 with the highest number of cases reported in 2008-2009. However, the fatalities rates per a given population has decreased over ten years from 2003 to 2013 (Pointer, 2013; BITRE, 2013). However, the decrease was not noted in all Australian jurisdictions as Queensland and Tasmania have had their rates increasing over the same period. Significant decreases in the rates were observed in NSW, Tasmania and South Australia states. For a 9 year period up to 2008-2009, the age-standardised rates for seriously injured persons as a result of RTIs rose from 138.3 to about 156.7/100000 people (Henly and Harrison, 2013). This represented a 1.6% average annual increase. Over the 9 years, the highest annual rates were recorded in the Northern Territory with the rates been 30-50% more than the national annual rates. All the States except Northern Territory and South Australia exhibited increases in age-standardised rates of injuries that were life-threatening over the period (Henly & Harrison, 2013). From 2000-2001 to 2008-2009, the number of individuals who had life-threatening injuries out of the seriously injured individuals as a result of RTIs was about 26% (Henly & Harrison, 2013). With the exception of pedestrians, all road users exhibited an increase in the number of reported life-threatening injuries over the 9-year duration. Pedal cyclists and motorcyclists had the highest increases in rates with an average annual increase of about 6.8% and 6.9% respectively. However, life-threatening injuries affecting passengers and occupants of motor vehicles showed n significant changes in the rates (Henly & Harrison, 2013). The rates of pedestrians who incurred life-threatening injuries as a result of RTIs decreased annually at a rate of 1.8%. The life-threatening injury rates relative to the number of registered transport means show that motorcyclist for every 10000 registered motorcycle were 9-10 times more likely to be seriously injured than motorvehicle occupants for every 10000 registered motorvehicle over the 9 year period (Henly & Harrison, 2013). The motorvehicle rates have been steady over the period. Nevertheless, the number of registered motorcycles has risen faster than the growth of the Australian population of the same period. The highest annual increases in rates were observed in individuals residing in remote areas. Both females and males in the 15-24 years age group had the highest age-specific rates of life-threatening RTIs over the 9-year duration from 1999-2000 to 2008-2009. Males aged 45-64 had the highest increase in reported annual rates with an average increase of 6.4%. The increases in rates were noted for most of the means of transport including motor vehicle, motorcycle and pedal cycle (Henly & Harrison, 2013). RTIs affecting pedestrians decreased over the period although the rates remain high for both females and males aged above 65 years. This could be attributed to the physiological derailments that set in with old age. Societal Burden RTIs comprise a significant burden to the Australian society. As of 1996, RTIs was the 12th leading causing of disease and injury burden in the Australian society (Mathers, Vos & Stevenson, 1999). In 2006, it was estimated that the social cost of RTIs was about $17.85 billion, an amount equivalent to 1.7% of the Australia’s GDP that year (Risbey, Cregan & De Silva, 2010). In 2003, road traffic crashes cost the Australian an amount equivalent to 2.3% of the GDP (Connelly & Supangan, 2006). The cost of RTIs affect humans and properties and can be grouped into fatality costing, injury costing, and vehicle and other costs. Components of fatality costs include losses in quality of life, workplace and household losses, hospital and medical costs, coronial costs, premature funeral, pain, grief and suffering, insurance administration, correctional services and workplace disruptions and costs for replacements (Risbey, Cregan & De Silva, 2010). In 2006, the fatality cost was about $3.8 billion representing 21.5% of the social cost as a result of RTIs. Injury costs include household and output losses, ambulance, medical, emergency services, legal, long-term care, recruitment and retraining, insurance administration, and workplace disruption costs. Injury cost was about $6.7 billion comprising 40% of the social cost of RTIs in 2006 (Risbey, Cregan & De Silva, 2010). Components of vehicle and other costs include vehicle unavailability, insurance administration, additional operating expenses, repairs and towing costs, travel delay, local air pollution costs, and street furniture repair costs. These costs comprised 38.5% of the social cost of RTIs estimated in the year 2006 (Risbey, Cregan & De Silva, 2010). Risk Factors for RTIs in Australia The risk factors can be grouped into factors affecting the exposure to RTIs, Influencing RTI involvement, influencing RTIs severity, and elements influencing the outcome of an RTI event as was postulated in Haddon’s matrix (World Health Organization, 2009; Australian Transport Safety Bureau [ATSB], 2004). Factors affecting the exposure to RTI These include demographic elements that include sex and age. The highlighted statistics demonstrate that men are more affected by RTIs than females across all age groups while the 15-24 age group is the dominantly implicated in RTIs for both sexes (Pointer, 2013; ATSB, 2004). Remoteness of the region also increases the likelihood of experiencing an RTI for an individual as demonstrated in Australia where the rates of RTIs per a given population are "higher in remote and very remote areas compared to major cities" (Pointer, 2013). Factors affecting RTIs involvement High speeds and inappropriate riding enhances the risk to RTIs. Areas with higher speed limits such as over 90km/hr have been shown to experience the highest number of RTIs (BITRE, 2013). This is so because the breaking distance is directly proportional to the speed hence affecting chances of a near miss too (WHO, 2009). The likelihood of killing a pedestrian increases with increasing speed. Alcohol intoxication enhances the risk of RTI, and it has the single major causal impact to RTIs in Australia. Research suggests that alcohol levels of about 0.05gm/100ml predispose a driver to a double likelihood of causing or experiencing an RTI (WHO, 2009). Fatigue is also another risk factor common in RTI involving long distance drivers. Additional factors include poor weather resulting in inadequate visibility, being a young man, poor road user's eyesight and distractions during driving such as use of mobile phones (ATSB, 2004). Factors affecting the severity of RTI These include excessive speed, poor utilization and not utilizing child restraints and seatbelts, not utilizing crash helmets by motorcyclists and pedal cyclists, alcohol and other drugs intoxication. Factors affecting post RTIs outcome Delay in identifying RTI victims or facilitating their transport to a health providing service center, alcohol intoxication during the injury, difficulty evacuating some victims of RTIs (ATSB, 2004). The latter is common when the wreckage after an RTI has some sections not easily accessible. Without a timely emergency rescue team, the prognosis of an RTI victim may worsen such as in cases where there is extensive loss of blood. Evaluation of RTIs Prevention Interventions The interventions that have been put in place in Australia shall be examined based on the Haddon’s Matrix where interventions are discussed targeting prevention at pre-event level, event level and post-event level and by incorporating the three Es of injury prevention (Christoffel & Gallagher, 2006). Interventions that have been implemented in Australia include random breath testing, Sit belt laws and speed enforcement programs (Stevenson & Thompson, 2013). Education Interventions Among the educative interventions in use in Australia include promotion of the utilization of seat belts for adults and special safety seats for children, educating on the repercussions of drunk driving and safety utilization of roads by pedestrians (ATSB, 2004). These interventions primarily target prevention at pre-event level. The education programs target school going children through education curriculum and adults through media campaigns. Education is meant to provide information related to RTIs, change the attitudes related to risks involved and to alter the behavior of the at-risk groups (Christoffel & Gallagher, 2006). It is evident that at risk group in Australia is the 15-24 year hence educative programs such as the road ready program, road ready plus programs targeting this group can be effective although their efficacy has not been demonstrated given the increasing high incidences of RTIs in this age group. Furthermore, school-based education programs have not shown actual reduction in child-related RTIs in Australia (ATSB, 2004). Engineering Intervention These include measures geared at making structural changes that enhance road safety. They target prevention at mainly pre-event level. These measures include using markings on the road to direct road users at complex intersections and at black spots. This has been effected through the Government's black spot program that begun in 1990 (ATSB, 2004). The first two years of program implementation exhibited significant benefits such as the reduction RTIs that were estimated to have saved the nation about $800 million. The effective engineering measures include introduction of roundabouts where appropriate, new traffic lights such as ‘turn’ and ‘No Turn’ arrows, medians, improved lighting, edge lines, speed bumps and shoulder sealing (ATSB, 2004). These measures have also demonstrated efficacy in other nations such as US and UK (WHO, 2011). Enforcement Interventions These interventions include establishment and enforcement of regulations and laws regarding use of seat belts and helmets, impaired driving, speed limits, dangerous driving such as using phones, and safety standards for motorcycles and motorvehicles (ATSB, 2004; WHO, 2011). They target prevention at all levels of the Haddon’s matrix. These regulations have had a significant impact on the reduction of RTIs rates in Australia since 1970. They include the Motor Vehicle Standards Act 1989 (MVSA) that specifies standards such as for deceleration while braking for a given motorvehicle. Other regulations include those providing for random breath testing for alcohol content, national alcohol blood alcohol content limit of 0.05mg/100ml, speed cameras, motorcycle’s compulsory daylight running lights, compulsory use of bicycle helmets in 1992, 50km/hr speed limit introduction in urban areas in 1998, introduction of uniform road rules in Australia 1999 such as a maximum speed limit of 110 in all roads, and alcohol interlock devices introduction (WHO, 2011; ATSB, 2004). Enforcement of some of these legislations has positively resulted in a decrease in death rates as a consequent of RTI, and they form the bulk of effective interventions towards RTIs. Most notable is the speed limit restriction that has been demonstrated that an average 1km/hr increase in speed has a 3% higher risk of RTIs and 5% risk of fatal RTI (WHO, 2009). The legislative measures have also been effective in other nations such as the UK, New Zealand, and German from 1991 to 2005 (Wood, Bellis & Watkins, 2010; WHO, 2011). Implementation of Effective Measure Interventions that have been very successful include random breath testing, seat belt laws and speed enforcement programs (Stevenson & Thompson, 2013). The success of these interventions is hugely attributed to their cheaper cost of implementation relative to their effectiveness in reducing RTI rates, fatalities, and deaths. These interventions are enforcement interventions hence the need of an equipped and thorough law enforcement agencies. Recommendations Despite the various interventions to reduce RTIs and their fatalities in Australia, the rates have consistently remain high for the 15 -24 year old age group and in Northern Territory, and have been increasing for RTIs involving motorcycles. Further research is requisite to identify the unique elements of these that make them respond poorly to the various interventions that have been implemented. There may be specific risk factors for such groups that are not been considered in strategizing and implementing interventions. Sample Haddon Matrix for reducing RTIs among young adults Phases Human Factors Agent Sociocultural Environment Physical environment Pre-event Driving experience and skills Vehicle inspection and maintenance initiatives Perceptions and attitudes on speeding and drunk driving Sufficient road markings and lighting Event Crash tolerance aide by seatbelt utilization Crashworthiness Mandatory seatbelt utilization enforcement Poor roadworthiness Postevent Victim’s sobriety Ease of access Public support in providing trauma care Emergency care service availability References Australian Bureau of Statistics. (2012). Accidents, Injuries and fatalities. Retrieved from http://www.abs.gov.au/ausstats/abs@.nsf/Lookup/by%20Subject/1301.0~2012~Main%20Features~Accidents,%20injuries%20and%20fatalities~189 Australian safety Transport Bureau. (2004). Road safety In Australia. Civic Square, ACT: Australia Transport Safety Bureau. Bureau of Infrastructure, Transport and Regional Economics. (2013). Road deaths Australia 2013 Statistical summary. Canberra: BITRE Commonwealth of Australia. Christoffel, T. & Gallagher, S.S. (2006). Injury prevention and public health: Practical knowledge, skills, and strategies (2nd ed.). Sudbury, MA: Jones and Barlett Publishers, Inc. Connelly, L.B. & Supangan, R. (2006). The economic sosts of road traffic crashes: Australia, states and Territories. Accident Analysis & Prevention, 38(6), 1087-1093. Henly, G. & Harrison, J.E. (2013). Injury of Aboriginal and Torres Strait Islanders people due to transport2005-06 to 2009-10. Canberra: AIHW. Mathers, C., Vos, T. & Stevenson, C. (1999). The burden of disease and injury in Australia. Canberra: AIHW. Pointer, S. (2013). Trends in hospitalized injury, Australia 1999-00 to 2010-11. Canberra: AIHW. Risbey, T., Cregan, M. & De Silva, H. (2010). Social cost of road crashes. Canberra: Bureau of Infrastructure, Transport and Regional Economics. Stevenson, M. & Thompson, J. (2013). On the road to prevention: road injury and health promotion. Health Promotion Journal of Australia, 25(1), 4-7. Wood, S., Bellis, M.A. & Watkins, S. (2010). Road traffic accidents. A review of evidence for prevention. . London: UK Focal Point for Violence and Injury Prevention. World Health Organization. (2009). Risk factors for road traffic injuries. Retrieved from http://www.who.int/violence_injury_prevention/road_traffic/activities/roadsafety_training_manual_unit_2.pdf World Health Organization. (2011). Chapter III. Interventions and results: What is the evidence. 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