Driven by WHO? Is road traffic injury prevention heading in the wrong direction?

1. Driven by WHO? Is road traffic injury prevention heading in the wrong direction? 11/10/2011 Measuring lifestyle: methods and limitations Presenter: Gareth R Davies

2. Overview Overview • Road traffic injury epidemiology • UN public-private partnerships • Road traffic injury prevention • Content analysis • Dissemination • Road traffic injury epidemiology • Road traffic injury prevention & the UN • Global Road Safety Partnership • Research question and method • Results and conclusions Driven by WHO?

3. Leading causes of death worldwide Overview • Road traffic injury epidemiology • UN public-private partnerships • Road traffic injury prevention • Content analysis • Dissemination 2004 estimates 2030 projections 1 Ischaemic Heart Disease 2 Cerebrovascular disease 3 Lower respiratory infections 4 COPD 5 Diarrhoeal diseases 6 HIV/AIDS 7 Tuberculosis 8 Lung Cancer 9 Road traffic accidents 10 Prematurity & low birth weight 1 Ischaemic Heart Disease 2 Cerebrovascular disease 3 COPD 4 Lower respiratory infections 5 Road traffic accidents 6 Lung cancer 7 Diabetes Mellitus 8 Hypertensive heart disease 9 Stomach cancer 10 HIV/AIDS Source: Global Burden of Disease update (WHO 2008) Driven by WHO?

4. Forecast Overview Source: Global Burden of Disease update (WHO 2008) Driven by WHO?

5. Where? Overview Source: Global Status Report on Road Safety (WHO 2009) Driven by WHO?

6. Where? Overview WHO Region 92% of road deaths 85% of population 48% of vehicles 0 Number of road traffic deaths 2004 Source: Global Burden of Disease update (WHO 2008) Driven by WHO?

7. Road users Overview Source: Global Status Report on Road Safety (WHO 2009) Driven by WHO?

8. Age at death Overview Source: Global Burden of Disease update (WHO 2008) Driven by WHO?

9. Gender Overview High Income Countries (HIC) Low & Middle Income Countries (LMIC) Source: The World Report on Road Traffic Injury Prevention (WHO 2004) Driven by WHO?

10. United Nations response Overview • 1974 – World Health Assembly called for action from governments, health care and manufacturers • 2000 – WHO five year strategy for road traffic injury prevention • 2003/04 – UN resolutions including creation of UN Road Safety Collaboration (UNRSC) to be led by WHO • 2004 – WHO & World Bank - World Report on • Road Traffic Injury Prevention • 2008 – WHO - Global Status Report • 2011 – UNRSC - Decade of Action Driven by WHO?

11. Paradigm shift Overview • Road crash injury is largely preventable and predictable • Road safety is a multi-sectoral issue and a public health issue • Common errors and behaviour should not lead to death/injury • Vulnerability of human body = limiting design parameter • Road crash injury is a social equity issue • Technology transfer needs to fit local conditions • Local knowledge is needed for local solutions Driven by WHO?

12. Haddon Matrix Overview Source: Haddon Jr, W (1979) Options for the prevention of motor vehicle crash injury. Israel J Med Sci 16(1) p45-65 Driven by WHO?

13. World Report Intervention themes Intelligent vehicles Overview Vehicle visibility Design Helmet use Speed limits Improving vehicles Alcohol / drug limits Traffic lights Setting and enforcing rules Hours of work Seat belts Reduce traffic Safety in planning Safety in design Safer modes Chain of help Managing exposure Shaping the road network Delivering post crash care Source: The World Report on Road Traffic Injury Prevention (WHO 2004) Reduce exposure Remedial action Driven by WHO?

14. World Report interventions Overview 5 Themes Managing exposure to risk through transport & land use policies 18 Objectives Reducing Motor Vehicle Traffic 58 Actions Efficient land use 86 Activities Spatial distribution of origins & destinations of road journeys Driven by WHO?

15. Global Public Private Partnerships Overview • A basic definition of a GPPP is of a partnership that • Involves at least one of both private for profit and • not for profit organisations • Jointly shares both the efforts and the benefits • Has a commitment to the creation of social value • Reich (2002) • GPPP’s can be categorised as • Product based • Product development based • Systems/issue based • Buse & Walt (2000) Driven by WHO?

16. Global Road Safety Partnership Overview • The principle objective of the GRSP is to • “…facilitate the sustainable reduction in road traffic casualties [In LMIC’s] through partnerships between business, civil society and government. • GRSP’s main activities are to identify and promote relevant good practice and to support or deliver projects involving collaboration between two or more partners which are designed to test and demonstrate good practice in reducing the number of road casualties” Source: Global Road Safety Partnership constitution (GRSP 2009) Driven by WHO?

17. GRSP members Overview • European Union • European Commission • Vehicle manufacturers • DaimlerChrysler AG • Ford/ Volvo • GM • Honda • Renault SAS • Toyota • Volvo • Petroleum producers • BP • Chevron • Shell • Total • Host agency • International Federation of the Red Cross and Red Crescent Societies • Not-for-profit transport and safety research agencies • ISTED (Institut des Sciences et des Techniques de l'Equipement et de l'Environnement pour le Développement, France) • TRL (Transport Research Laboratory Ltd, UK) • NHTSA (National Highway Traffic Safety Agency, USA) • VTI (Transport Research Laboratory, Sweden) • United Nations and WHO • UNECA (United Nations Economic and Social Commission for Africa) • UNECE (United Nations Economic and Social Commission for Europe) • UNESCAP (United Nations Economic and Social Commission for Asia and the Pacific) • UNESCWA (United Nations Economic and Social Commission for Western Asia ) • World Bank • World Health Organisation • Tyre manufacturers • Bridgestone • Michelinc • Commercial interests in road freight • International Road Transport Union • TNT Express • International Development Agencies • DFiD (Department for International Development, UK) • SIDA (Swedish International Development Cooperation Agency) • Commercial interests in motor sport • FIA Foundation • Commercial interests in road infrastructure • Australian Road Research Board group LTD • African Development Bank • Asian Development Bank • Inter-American Development Bank • Not-for-profit industry sponsored alcohol agency • International Centre for Alcohol Policies Driven by WHO?

18. Concerns Overview • PricewaterhouseCoopers (2002) - shift from a study of tri-sector partnership to a direct promoter of road safety • SIDA (2004) – functioned well organisationally, heavily reliance on information, education and training, little activity in some focus countries, hardly any project evaluation. • Harvard University (2006) – lack of programme evaluation and lack of feedback on differing partnership approaches. Question raised over effectiveness of partnership against effectiveness of partners acting alone. • Roberts et al (2006) – Emphasis on education, for which there is a lack of evidence of effectiveness Driven by WHO?

19. Research questions Overview Are the communications of the GRSP biased towards specific types of road traffic injury prevention activities? If so, to what extent? and what are the characteristicsof the preferred interventions? Driven by WHO?

20. Communication model Overview ANTECEDENT CONDITIONS individual psychological/professional social, political, economic, cultural or other contextual factors that are assumed or demonstrated to affect COMMUNICATION CONTENT which is an antecedent/correlate of assumed or demonstrated immediate or delayed individual, social or cultural EFFECTS Source: RIFFE D et al 2005. Analyzing Media Messages Driven by WHO?

21. Research method Overview “Quantitative content analysis is the systematic and replicable examination of symbols of communication, which have been assigned numeric values according to valid measurement rules and the analysis of relationships involving those values using statistical methods, to describe the communication, draw inferences about its meaning, or infer from the communication to its context, both of production and consumption.” (Riffe 2005) • Suitability • Unobtrusive • Handles unstructured data • Copes with large volumes of data Driven by WHO?

22. Data Overview Driven by WHO?

23. Dictionaries Overview Driven by WHO?

24. Results – GRSP News Overview Driven by WHO?

25. Results – Around GRSPs World Overview Driven by WHO?

26. Results – Project Summaries Overview Driven by WHO?

27. Overview Driven by WHO?

28. Why? Overview Driven by WHO?

29. So what? Overview • Global Road Safety Partnership (2001+) – FIAF & business partners • Global Road Safety Initiative (2005-2009) – GRSP business partners • Global Road Safety Facility (2006-2010) – FIAF • Commission on Global Road Safety (2006+) – FIAF • Road Safety Fund (2011+) – FIAF & GRSP business partners • “… supports catalytic programmes that focus on sustainable behavioural change…We know what works; we now need the resources to help developing countries catalyse sustainable road traffic injury prevention.” Driven by WHO?

30. So what? Overview • For motorized road transport to become sustainable the following must be addressed • Depletion of non-renewable energy source • Global atmospheric impacts • Local atmospheric and noise impacts • Crash fatalities and injuries • Congestion • Decreased physical activity Driven by WHO?

31. Conclusion Overview Road traffic injuries are part of a set of public health problems associated with unsustainable transport and should not be viewed in isolation The UNRSC should independently review the distribution of funds in terms of the range of interventions and the outcomes of them. Evaluation must be designed in at the outset and monitored. Care must be taken to prevent public-private partnerships world views coming to predominate the whole policy arena. Driven by WHO?