Adnan A. Hyder MD MPH PhD Professor, Department of International Health Director, International Injury Research Unit (IIRU) Johns Hopkins Bloomberg School of Public Health
EMR has Second Highest RTI Death Rate
Estimated RTI death rate by EMR country: GSRRS 2015 80 60 40 20 0 PSE BHR ARE EGY PAK QAT AFG KWT IRQ MAR YEM LBN SDN TUN DJI OMN SOM JOR SAU IRN LBY
Death rate per 100,000 Income EMRO countries GHE 2014 GSRRS 2015 category 21.5 15.5 Afghanistan Low 7.6 8.0 Bahrain High 11.6 24.7 Djibouti Middle RTI 13.6 12.8 Egypt Middle 41.9 32.1 Iran Middle mortality 30.2 20.2 Iraq Middle data source 19.9 26.3 Jordan Middle comparisons 12.3 18.7 Kuwait High 17.2 22.6 Lebanon Middle 32.5 73.4 Libya Middle 18.5 20.8 Morocco Middle 27.2 25.4 Oman High 16.9 14.2 Pakistan Middle 9.8 15.2 Qatar High 18.4 27.4 Saudi Arabia High 17.7 25.4 Somalia Low 25.0 24.3 Sudan Middle 18.4 24.4 Tunisia Middle 9.8 10.9 United Arab Emirates High - 5.6 West Bank/Gaza Middle 25.9 21.5 4 Yemen Middle
Reported Versus Estimated RTI Deaths in the GSRRS 2015 5,000 0 R I E T T N E N R M N Y G M Q R U N Y N K J S A W R B G A H M B O U F R A A D R D O E P Q L P A L A M S I B J T Y I S E K O S Reported RTI deaths Estimated - reported RTI deaths
Ratio of Estimated to Reported RTI Deaths by GNI per capita SDN 4 Low-income countries 3 Middle-income countries AFG PAK JOR 2 High-income countries PSE MAR TUN LBN YEM QAT ARE IRN KWT BHR EGY IRQ LBY SAU OMN 1 0 20000 40000 60000 80000 100000 Gross National Income per capita (US$) Source: GSRRS 2015
RTI Death Rate by GNI
Estimated RTI death rate by income group Income level Number of RTI deaths Population RTI death countries (million) rate (per 100,000) Low 2 7,398 41 18.02 Middle 13 99,999 505 19.79 High 6 10,909 49 22.41 World Bank 2013: • Low-income = ≤ US$ 1,035 GNI per capita; • Middle-income = US$ 1,036 to US$ 12,615; • High income = ≥ US$ 12,616. Source: GSRRS 2015 & World Bank
Registered Cars and RTI Deaths by Income Group Percentage of Registered Cars Percentage of RTI Deaths 1% 6% 9% 18% Low Middle High 81% 85% Source: GSRRS 2015
Road Traffic Deaths by VRUs in EMR Source: GSRRS 2015
Pause…. • Variations in current sources of data important to understand – Reported vs. modelled or GBD vs. GHE vs. GSRRS • Higher income in EMR appears to predispose to higher RTI impact – Middle income biggest proportion • Data on major risk factors missing in the region – Need to know prevalence and distribution • This information is important for evidence based enforcement – Needed to understand impact of laws/changes over time
Estimated Helmet wearing rates (%) GSRRS 2015 Other Studies Countries Drivers Passengers All Drivers Passengers All 35 12 - 13 - 21.5 - 10 - 47 Iran 43 8 - - - - Morocco 95 - - - - - Oman 10.4 - 10.4 50.9 5.8 35.5 - 56 Pakistan United Arab - - - - 0 - 13 Emirates 4 0 - - - - Yemen
Estimated seat-belt wearing rates (%) GSRRS 2015 Other Studies Countries Front- Rear- Driver All Driver Front-seat Rear-seat All seat seat Bahrain 20 - - - - - - - Egypt 13-18 3-4 - - 11-55 3 – 4.0 - - Iran 92 85 10 50 78 44 - 50 – 71 Jordan 42 - - - - - - - Kuwait - - - - 42 31 7 - Lebanon 13 - - - 46 41 - 44 Morocco 50 46 - - - - - - Oman 97 - - - 91 81 1 - Pakistan - - - - 15-20 - - 16 Qatar - - - - 20 – 77 - - - Saudi Arabia - - - - 28-87 4-30 2 - United Arab Em. - - - - 29-86 14-88 2-11 59
Estimated rates of child restraint use (%) Countries GSRRS 2015 Other Studies - 1.1 – 3.9 Egypt - 26 Kuwait - 3.7 – 16.7 Oman
Proportion of RTI deaths attributable to Alcohol (%) Countries GSRRS 2015 Other Studies Bahrain 2.9 - Iran - 12.3 - 23.5 Jordan - 4.5 Libya 1.6 - Morocco 3 - Oman 0.4 - Pakistan - 11 Tunisia 1 - United Arab Emirates - 2.1
7 Road Safety Laws Captured in GSRRS, 2015 • Speed limits at national level • Drink-driving law • Drug-driving law • Helmet law • Seat-belt law • Mobile phone law • Child restraint law
Overview of Road Safety Laws in the EMR 25 21 21 20 20 19 19 18 # of countries 15 10 5 5 0 Speed limits at Drink-driving Drug-driving Helmet law Seat-belt law Mobile phone Child restraint national level law law law law Road safety laws
Summary of number of laws in EMR Names of countries Number of Number of laws* countries Bahrain, Lebanon, Oman, Saudi Arabia and 7 5 West Bank and Gaza Strip Egypt, Iran, Iraq, Jordan, Kuwait, Libya, 6 13 Morocco, Pakistan, Qatar, Sudan, Tunisia, United Arab Emirates and Yemen 5 - 4 1 Djibouti 3 2 Afghanistan, Somalia 2 - 1 - *Speed limits at national level, Drink-driving law, Drug-driving law, Helmet law, Seat-belt law, Mobile phone law and Child restraint law **No Child restraint law ‡ No Drug-driving , Mobile phone law and Child restraint law ¶ No Helmet law, Seat-belt law, Mobile phone law and Child restraint law
Overview of Road Safety Laws by Income Group HIC MIC LIC 20 15 13 13 13 13 12 12 # of countries 10 6 6 6 6 6 6 5 3 2 2 2 2 0 Speed limits at Drink-driving Drug-driving law Helmet law Seat-belt law Mobile phone Child restraint national level law law law Road safety laws *World Development Indicators database: High income (HIC) is $12,745 or more, middle income (MICs) is $1046 to $12,745 and low income (LICs) is $1045 or less **There are six HICs, 13 MICs and two LICs
Speed-limit Laws in the EMR Yes No Not available 20 19 18 18 15 13 13 # of countries 10 8 8 5 2 2 1 1 1 1 0 Urban speed limit Rural Speed limit Motorway speed limit Modification of speed Speed limit around present present present limits by local school present authorities allowed Speed limit laws Enforcement of speed limit law 1 - 10
Speed-limit Overview in the EMR Average speed limit Range of speed limit Road type (km/hr) (km/hr) Urban 63 40 - 100 (18 countries) Rural 95 60 - 120 (19 countries) Motorway 112 80 - 130 (13 countries) Around school 35 30 - 40 (2 countries)
Drink-driving laws in the EMR Yes No 20 15 15 15 15 # of countries 11 10 10 6 6 6 5 0 BAC limit for general BAC limit for young drivers BAC limit for commercial Random breath test population present present drivers present conducted BAC – Blood Alcohol Concentration Drink-driving law Enforcement of drink driving law 1 - 10
Helmet laws in the EMR Yes No Not available 20 15 15 15 15 15 12 # of countries 10 7 5 4 4 4 4 2 2 2 2 2 0 Applicable to driver Applicable to passengerChild required to wear a Helmet standards are Fastening of helmet helmet present required Helmet laws Enforcement of helmet law 1 - 10
Seat-belt laws in the EMR Yes No Not available 20 15 12 12 # of countries 10 7 7 5 2 2 0 Applicable to front occupants Applicable to rear occupants Seat-belt laws Enforcement of seat-belt law 2 - 10
Child-restraint laws in the EMR Yes No Not available 20 16 16 16 15 15 # of countries 10 6 5 5 4 3 2 1 0 Law is based on age Law is based on weight Law is based on height Restriction on child sitting in front seat Child-restraint laws Enforcement of child-restraint law 0 - 6
Mobile phone laws in the EMR Yes No Not available 20 17 # of countries 15 13 10 5 5 3 3 1 0 Applicable to hand-held device Applicable to hand-free device Mobile phone laws Enforcement of mobile phone law Not available
Drug-driving laws in the EMR • There is no data on enforcement of the law
Road safety targets in the EMR Yes No Not available 20 18 17 17 15 # of countries 11 10 9 8 5 5 5 4 4 4 3 0 Presence of lead agency Presence of national Requirement of formal Presence of fatality Presence of non-fatal road safety strategy audit for new road reduction target road injury reduction construction projects target Road safety management
Pause… • Number (quantity) of laws appears to be satisfactory in most of EMR – Some MIC and LIC need review – Child restraint laws exception • However, details of the content & loopholes need review in many cases – E.g. front & rear seat, helmet standard, school speeds • But there is no data on enforcement (quantity and quality) of the laws – Critical component to implement & measure – Evidence based policing
Potential Interventions Dr. Margie Peden Coordinator Unintentional Injury Prevention WHO 31 | DCP3 EMRO meeting | 10 March 2016
Implementing prevention & control programmes Safe systems approach Political support & using the economic argument Promoting effective interventions (best buys and some EMR case studies) Building capacity Monitoring and evaluation 32 | DCP3 EMRO meeting | 10 March 2016
The Safe Systems approach 33 | DCP3 EMRO meeting | 10 March 2016
Getting political buy-in 34 | DCP3 EMRO meeting | 10 March 2016
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