Public Health for Road Safety
Focused on Prevention:
While health care and medicine treat morbidity and mortality on the individual level, public health focuses on the aggregate population. In addressing the problem of road traffic injuries at the collective level, public health practitioners pay attention to all three phases of injury—prevention, acute care, and rehabilitation—but most of all stress the importance of prevention.
Based on Science:Interventions are formed upon a foundation of scientific research and empirical observation. A four-step model is used in the design of road traffic injury prevention programs:
Step One: What is the problem? Who are the victims, what happened to them, where did it happen, when did it happen, and what are the consequences? Public health uses the discipline of epidemiology, looking at patterns of injury and disease in large populations, to answer these questions.
Step Two: What are the causes? What are the risk factors and what are the protective factors?
Step Three: What works to prevent road traffic injury? What is the evidence to prove that the intervention is effective?
Step Four: How can it be done? How can an intervention be implemented and spread? How can an effective demonstration be scaled up into a large-scale, well disseminated program?
The success of a science-based approach is dependent on our ability to conduct effective program evaluation. Although road traffic injury data collection has been improving in recent years, injury surveillance systems are often inadequate or non-existent in regions where they are most needed. National and regional capacity for injury data collection must be developed and they must focus on collecting the data that are most needed. Sound data provide the basis for diagnosing and treating the problem, determining the most effective intervention and evaluating its impact.
- Collaborative by Nature: Public health is not a single profession but a field of work that draws upon many different disciplines, including medicine, epidemiology, biostatistics, nursing, engineering, law enforcement, public policy, program management, anthropology, and psychology. Effective control of road traffic injuries requires collaboration among government departments (including transportation, law enforcement, health, finance, education, and urban planning), civil society, and the private sector. Collaboration is difficult but essential. The College of Traffic Management's School of Public Health seeks to develop partnerships with public health institutes and schools of public health both in India and in other countries. It will also pursue intersectoral collaboration, aiming to work with a wide range of government departments as well as with civil society and the private sector.
Primary Prevention: Public Health, aims to collect data on the magnitude, characteristics, extent and consequences of road traffic crashes through injury surveillance. Principles of epidemiology will be applied to analyze the patterns of incidence and determinants of injury. Behavioral science will be used to increase knowledge of the social and behavioral aspects of high-risk driving behavior.
The main areas of study will initially include:
- Stress and fatigue
- Falling health of heavy vehicle drivers of the unorganized sector
- Alcohol, drugs & driving
- Youth driving behavior
- Occupational Injury
- Post-crash management
Trauma Care & Rehabilitation: According to the Australian Academy of Science the word trauma is most suitable to describe the injuries caused by road crashes. More literally it refers to a powerful shock that may have long-lasting effects which is an appropriate description for the sudden violence of a road crash.
According to Mock et al (1993), people with life-threatening, but potentially treatable injuries are up to six times more likely to die in a country with no organized trauma system than in one with an organized resourced trauma system. In India today, there is a lack of understanding of what optimal trauma care could do and a failure to provide for optimal trauma care in the case of road traffic crashes. As a result, India ends up with a higher percentage of serious and fatal injury outcomes.
Institutions like the JPN Apex Trauma Center in New Delhi, have adequately demonstrated that immediate and appropriate trauma care where provided has led to a reduction of serious injuries and fatalities. There is a need to translate these findings across the country through continued research, training and program implementation.
The Trauma Research & Training Center at the School of Public Health for Road Safety is associated with the JPN Apex Trauma Center to undertake research on the type of injuries that occur and their consequences, research that should contribute to the development of tools and improved trauma systems as well as training. This training would be targeted at various stake-holders, including the first responders to crashes such as the highway patrol, traffic police, and ambulance staff. In rural areas the stake holders would include village panchayats, educational institutions along the highway and other non-governmental organizations.
Road traffic crashes not only affect the victims, but also their families, friends, and employers. In developing countries like India, the cost of long-term care for the injured or the loss of income due to disability drive many families into poverty. It aims to study post accident sequelae which are related to socio-economic determinants. Imparting knowledge in this sector would help reduce disability and catalyze the process of rehabilitation.
IRTE formed the School of Public Health for Road Safety to examine issues in primary prevention, trauma care, and rehabilitation. Epidemiological and statistical analysis of road safety data will be used to address a number of priority areas:
Risk and protective factors with respect to road users: Road safety can only be improved once the factual causes and consequences of road crashes are known. Police records and crash data in India list drivers as being responsible for majority of the road crashes, blaming them for serious violations and carelessness. These are only a partial set of possible risk and precipitating factors. Available research from organizations like NIMHANS & IRTE have estimated that many crashes due to driver negligence could be attributed to physical and mental conditions. Police reports do not reveal other contributing factors about road users such as a driver's ill health, stress, fatigue, tiredness or visual impairment which may have contributed to these crashes.
Analysis of crash data: Furthermore, another dark area of statistical information is the number of minor and serious injuries and fatalities and the factors that catalyze these. Official statistics from the government of India indicate there were 126,000 fatalities in addition to 4428,000 serious injuries for 2009, the most year for which data are available. This does not seem to be consistent with the Sundar Committee report which estimated that there are 15-20 times as many serious injuries as reported fatalities. Using this estimate, there would be more than 2,000,000 serious injuries in 2009 compared to the 428,000 injuries listed in official government data.
Investigation of delays in transportation or mishandling of crash victims: it would be important to look into how many injuries became serious injuries and how many serious ones turn into fatalities due to delays in transportation or lack of optimal trauma care. Additionally, we lack information about what happened to the injured persons in their lifetime, and how many of these victims subsequently died or suffered from disabilities during the course of their life.
Road Traffic injuries and deaths are preventable and it is only in the recent years that road safety is being considered a serious health problem. Public Health has a very important role to play. The School of Public Health for Road Safety seeks to generate and spread knowledge with the aim of preventing road traffic crashes and reducing the severity of an injury in case of a crash, by conducting innovative research, translating research into effective interventions, and training new and future leaders from diverse back grounds.