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

1. Jonathon Passmore Technical Officer, Road Safety and Injury Prevention, WHO Viet Nam Motorcycle helmet wearing in Viet Nam ..... is the job done?

2. 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

3. RTI as leading cause of death Source : VINE Project 2008

4. Source : WHO GBD 2004

5. Disability Adjusted Life Years (DALYs) Source : VINE Project 2008

6. Years of Life Lost (YLL) Source : VINE Project 2008

7. Road safety management National Mass Organisations Public private partners International Organizations PRIME MINISTER DEPUTY PRIME MINISTER Minister of Transport Vice Minister Public Security National Traffic Safety Committee Secretariat 63 Provincial TSC’s Standing Office

8. Road trauma in Viet Nam

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

10. 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

11. History of helmet legislation in Viet Nam 2001 TCVN helmet standards for adults & children RS Law MOT Circ Decree 39 (penalty) 2010 Decree 34 (penalties) Wearing for children 2007 Resolution 32 Mandatory helmet wearing 1997 NTSC formed 2009 Revised RS law Helmet wearing full law Fastening 2008 QCVN standards revised Single standard covering adults & children 1998-2000 TCVN helmet standards for adults & children RS Law 1995 Decree 36

12. National helmet law Pre law Post law 15 December 2007: Helmet Law + Enforcement + Education

13. What contributed to the success this time? • Political support • Highest level (Prime Ministers Office & the Party) • Whole of Government approach (NTSC coordinated) • Demonstrated effectiveness of helmets • Confidence a helmet law could be successful if implemented correctly • Implemented in effective manner • 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

14. 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

15. Social marketing • NTSC commenced SM campaigns in 1998 • In 2007, partnerships with AIPF commenced targeted campaigns • TV, Cinema, Posters, Billboards, bus shelters etc

16. Social marketing

17. Social marketing

18. Social marketing

19. 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 6-12) 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

20. Infringements – All infringements vs helmets only

21. Motorcycle helmet wearing –long term trend

22. 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

25. Wearing rates in Hanoi

26. 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 2008 vs 2007 1,557 ↓ death 2,495 ↓ serious injuries 2009 vs 2008 149↓ death 212 ↓ serious injury 2010 vs 2009 65↓ death 2747 ↑ serious injury * Jan-Oct

27. Pre/post law impact – Health data • National injury surveillance system in operation • Commenced 2008 • No pre law data • Declining reporting since • 2008 - 92/100 hospitals • 2009 – 84/100 hospitals • 2010 - 43/100 hospitals

28. Hospital records - Head injuries

29. Pre/post law impact – Health data * 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)

30. 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 un-worn • 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

31. Helmet wearing in primary school aged children

32. Helmet wearing in secondary school aged children

33. Child helmet wearing February 2011 (weekday)

34. Child helmet wearing, February 2011 (weekend)

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

36. Quality of standard helmets Latest results from June 2011 • 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

37. Quality of standard helmets

38. Some helmets are better than others!

39. 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

40. Helmet standards - Tropical vs ECE 22

41. How does a helmet protect the brain?

42. How does a helmet protect the brain?

43. How does a helmet protect the brain?

44. 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

45. 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)

46. 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

47. THANK YOU passmorej@wpro.who.int