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Motorcycle helmet wearing in Viet Nam ..... is the job done?
Jonathon PassmoreTechnical 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
National Traffic Safety Committee
DEPUTY PRIME MINISTER
Standing OfficeSecretariat63 Provincial TSC’s
Public private partnersNational Mass Organisations
International Organizations
Minister of Transport Vice Minister Public Security
Road trauma in Viet Nam
NTSC/MPS MOHRoad traffic deaths (2009) 11,094 15,012
Road traffic injuries (2010) 10,306 435,181
Mortality rate 12.9/100K 17.4/100K
0
5,000
10,000
15,000
20,000
25,000
30,000
35,000
1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
# of road crashes Deaths Injured
Road traffic injury mortality by province, 2008
• Large variation in mortality rates• Anecdotally associated with major
transport hubs (national/international roads)
30+20-2910-19
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
0
5,000,000
10,000,000
15,000,000
20,000,000
25,000,000
30,000,000
35,000,000
1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
Motorcycles Cars, Buses, Trucks
History of helmet legislation in Viet Nam
1995 Decree 36
2010Decree 34 (penalties)Wearing for children
1997 NTSC formed
2001TCVN helmet standards
for adults & childrenRS Law
MOT Circ Decree 39 (penalty)
2007Resolution 32
Mandatory helmet wearing
1998-2000TCVN helmet standards
for adults & childrenRS Law
2009 Revised RS law
Helmet wearing full law Fastening
2008QCVN standards
revised Single standard
covering adults & children
National helmet law
Pre law
Post law
15 December 2007: Helmet Law+ Enforcement + Education
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 armedforces
– 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 NTSCMinistry of TransportCoordinated development of legislation; instructing other members of the NTSC, and
the 63 PTSC on implementation of the law
Ministry of Public Securitynationwide 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 TrainingSchool 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 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
Infringements – All infringements vs helmets only
5,431,1915,589,635
6,362,907
682,789526,510
940,601
0
1,000,000
2,000,000
3,000,000
4,000,000
5,000,000
6,000,000
7,000,000
2008 2009 2010
infr
inge
men
ts
Total infringements Helmet wearing violations
Motorcycle helmet wearing –long term trend
72.9
88.1
81.980.7
91.0
85.4
27.5
99.5 99.0 98.0 99.0 98.9
47.9
94.396.4 96.0
97.9
93.9
50.7
80.2
62.565.2
75.272.8
21.7
97.5
86.884.6
91.6
86.8
42.1
87.690.6 90.3
94.6
87.6
0
20
40
60
80
100
120
Nov-07 Jun-08 Dec-08 May-09 Sep-09 Feb-11 Nov-07 Jun-08 Dec-08 May-09 Sep-09 Feb-11 Nov-07 Jun-08 Dec-08 May-09 Sep-09 Feb-11
Yen Bai Da Nang Binh Duong
Riders Passengers
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
• 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
Deaths Serious injuries2007 12,800 11,0972008 11,243 7,7712009 11,094 7,5592010 11,029 10,3062011* 8,903 8,055
* Jan-Oct
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
2008 2009 2010Road traffic injuries 183,058 143,940 117,317
% of RTI with head injuries
27.1% 25.3% 17.8%
Hospital records - Head injuries
20,925
19,280
17,813
6,639
5,399
17,94020,130
19,881 19,501
7,326
8,084
7,298
7,3297,372
-
5,000
10,000
15,000
20,000
25,000
2004 2005 2006 2007 2008 2009 2010
Road traffic injuriesRoad traffic head injuries
Pre/post law impact – Health data% change RR 95% CI
All injuries 2007 vs 2008 -1.04% 0.98* 0.97-0.99
2007 vs 2010 -5.82% 0.88* 0.87-0.89
Road traffic injuries 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
RT fatalities 2007 vs 2008 -0.16% 0.76* 0.59-0.99
2007 vs 2010 0.32% 1.25 0.99-1.56
* 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 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
Helmet wearing in primary school aged children
0.0%10.0%20.0%30.0%40.0%50.0%60.0%70.0%80.0%90.0%
100.0%
2009 2010 2009 2010 2009 2010 2009 2010
Yen Bai Hanoi Da Nang Can Tho
Correct Incorrect No helmet
Helmet wearing in secondary school aged children
Child helmet wearing February 2011 (weekday)
Child helmet wearing, February 2011 (weekend)
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
Quality of standard helmets
• 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
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 non- standard helmets
50.2% 15.1% 40.2%
Latest results from June 2011
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 (hemispherical)
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.
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