Activities of the Bloomberg Philanthropies Global Road Safety Programme (formerly RS10) in Russia: promising results from a sub-national project
Introduction
According to the World Health Organization (WHO), every year, nearly 1.3 million people are killed and another 20 to 50 million sustain non-fatal injuries as a result of RTIs.1 The WHO also projects that, unless immediate action is taken, RTIs are expected to rise from the eighth to the fifth leading contributor of the global burden of disease and injury by 2030 and will remain the leading cause of death among all injury deaths worldwide.1
Russia is an upper-middle- income economy country with a higher mortality rate due to RTIs (per 100,000 population) than any WHO-European Region country.2 Every year on Russian roads, nearly 30,000 people are killed by road traffic injuries (RTIs) and about 260,000 are injured or permanently disabled.3 The dramatic increase in RTIs rates in Russia can be attributed to factors such as rapid motorization and urbanization, which results in increased exposure levels to risk factors of RTIs. At the same time road safety policies, transport infrastructure, and interventions have not kept pace with the boom in motorization. In 2008, the estimated cost of RTIs in Russia was approximately US$26 billion.4 In 2011, RTIs became the fourth cause of injury fatalities and accounted for 75% of all types of injuries and 60% of severe trauma cases.3, 5 Road traffic mortality rate in Russia peaked in the early 1990s (26.0 per 100,000 population) and, after an initial fall in 1997 (by 19.0 per 100,000 population), rose again by 23.9 per 100,000 populations in 2004 and has been in decline since (19.6 per 100,000 population in 2012). WHO estimates that majority of traffic fatalities in Russia occur among car occupants (57%), followed by vulnerable road users (42%).1 Speeding vehicles as reported cause one-third of car crashes in Russia.3
The use of seatbelts has been shown to be an important means of reducing the risk of death or serious injury in a road crash by almost 50% for front seat occupants, and about 25% to 75% for rear seat passengers.6, 7, 8 Child restraints, if correctly installed and properly used, can reduce road traffic deaths by 70% in infants and 54–80% in small children.9 Developed countries have relatively high seatbelt use rates: as high as 97% for front occupants and 92% for rear seat occupants in Australia and 93% and 87% respectively in Canada.1 Seatbelt wearing rates in low- and middle-income countries (LMICs) are lower, as low at 0% and 1% in Cambodia and Chad respectively.1 There are exceptions, such as Colombia, which has reached 82%. Brazil, China and South Africa have seatbelt wearing rates between 50% and 80%.1 Russia made seatbelt-wearing compulsory in 1975 for drivers, front seat and rear seat passengers, and in 2005 mandatory child restraints use for children under 12 years of age was added to the Road Traffic Rules provisions concerning child safety.10 WHO examined the seatbelt rate (97% front seat occupants, 8% of rear seat passengers) and ranked effectiveness of seatbelt law enforcement as 7 out of 10.1
The problem of excessive speed has long been recognized as a major factor in road traffic crashes causation and is a major road safety problem in all countries.1, 11 The role of speed limits and road crashes has also attracted considerable debate over the years with a numbers of studies evaluating the effects of reduced speed limits on crash involvement and injury rates.12, 13 According to the Organization for Economic Co-Operation and Development's International Transport Forum (OECD ITF) speed is a contributory factor in 29% of road traffic deaths and speed limits are widely flouted on Russian roads.1, 9
The overall goal of the Bloomberg Philanthropies Global Road Safety Programme (formerly known as the Road Safety in 10 Countries Project, or RS10, and hereafter referred to as “the Global Road Safety Programme”, or, “the programme”) in Russia is defined as supporting the government in the implementation of its national objectives and preventing deaths and serious injury on the country's roads.14 In 2012, Russia saw 27,991 road deaths and 258,618 police-reported non-fatal road traffic injuries. In Russia, seatbelts non-use and speeding are the two risk factors being targeted by the program through legislation, police enforcement and social-marketing campaigns. The program is led in-country by the Department of Road Safety within the Russian Ministry of Interior and jointly implemented by other governmental departments at the national and regional level in two interventions sites, Ivanovskaya and Lipetskaya Oblast. Criteria for the selection of the sites included the road safety situation, the population size, readiness to start large project and, political will and support to road safety activities. A National Advisory Board to the program was then established, and a joint work plan of activities with inputs from international consortium partners, as well as federal and regional partners was prepared and approved.
The program interventions on seat belt were first designed and carried out in Lipetskaya Oblast, where the seat belt campaign was formally launched in November 2010, and in Ivanovskaya Oblast in May 2011. A new social marketing with the motto “Do not disconnect the line of life”.15 A social marketing speed campaign similar to that on seat belt was officially launched in August 2011 in Lipetskaya Oblast and in April 2012 in Ivanovskaya Oblast. The motto of the speed campaign was, “Life is more important than speed”.2, 5
The overall goal of this paper is to provide an interim assessment of the current situation in both interventions sites, and to suggest, on the basis of these preliminary results, recommendations for future road safety initiatives. This paper will add to what is known about seatbelt use and speeding in Russia by examining a number of road behaviors and establishing a benchmark of safety in two Russian region by providing a: a) seat belt wearing rates for all seat positions and b) percentage of speeding vehicles by speed limit and road types. This study was undertaken by a research team at the Johns Hopkins Internationally Injury Research Unit (JH-IIRU) at the Johns Hopkins Bloomberg School of Public Health (JHSPH) in partnership with the Lipetsk and Ivanovo State Universities of Technology. Previous literature has demonstrated the advantage of observational studies on seatbelt use to establish a benchmark of safety on the roads, but very little data was collected on seatbelt use and speeding in Russian regions. To our knowledge, this is among the first such attempt in Russia to provide such information. This study hopes to guide the effective enforcement of existing policies surrounding these two risk factors, or develop more targeted social marketing and public education campaigns in the country.
Section snippets
Methods
Lipetskaya Oblast, is part of the Central Federal district and located approximately 500 km southeast of Moscow.16 The population of Lipetskaya Oblast is 1,165,800 of which 67% live in urban areas and 33% live in rural areas.17 In Lipetskaya Oblast, the rate of RTIs is slighter higher than in the Russian Federation, at 23.1 per 100,000 population and 249.1 per 100,000 population representing 271 deaths and 2,927 non-fatal road traffic injuries in 2012.2 The second Intervention site is also part
Results
In total 30 rounds of observational studies was conducted with an overall sample size of 909,120 between October 2010 and March 2013.
Figure 2 demonstrates the preliminary findings of the ten rounds of observational studies for seatbelt use and child seat use in Lipetskaya Oblast. It can be seen that seatbelt use has continuously increased among both drivers and passengers over this time period. For drivers, seatbelt use increased from 55.7% (N=26,897 in October 2010) to 74.8% (N=22,163 in
Discussion
There is a very little current research underway in country to identify and explain the role of vehicle speed in road behavior and traffic crashes; our study is among the first to assess and describe the changes in the regional risk factor prevalence over time that measured in the sequential roadside observations. As in high-income countries, adoption of proven road safety legislation and strategies supported by the targeted social marketing campaigns could contribute to reducing the Russian
Conflict of interest
All authors have no conflict of interest to declare.
Acknowledgments
The authors would like to acknowledge the cooperation and guidance provided by numerous individuals and organizations in the project including: the WHO Country Office, Moscow, Russia, and the Global Road Safety Programme Consortium Partners (WHO, Global Road Safety Partnership, World Bank). This work was conducted as part of the Global Road Safety Programme, funded by Bloomberg Philanthropies.
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