To arrive at the point of examining road traffic injury (RTI) deaths in Australia, I first take you to Haiti, where I have lived for over five years. When describing the driving conditions in Haiti, I often say, “Driving here is at times just organized chaos. It isn’t that drivers are looking to hit pedestrians, they just aren’t looking to avoid them.” In Haiti, despite laws that may say otherwise, pedestrians do not have the right of way.

That brings me to deaths from road traffic injuries. As part of our study of non-communicable diseases and injuries, I looked at the top causes of death for both Australia and Haiti. And what stood out to me was how in Haiti, despite being just half the population of Australia,[1] there were drastically more deaths from road traffic injuries (4,487 vs. 1,661, respectively).[2,3] Road injuries are the 5th leading cause of death in Haiti, yet they are the 12th leading cause of death in Australia.[2,3] While startling, it didn’t come as a complete surprise, as per my previous comments, driving in Haiti is not exactly the safest experience.

(One of the main reasons that I chose Australia as my country of focus for this Global Health Challenges course is that I wanted to learn more about places doing things well. Countries with success in tackling health and development issues. From my perspective, Australia fits this criterion. And while Australia is widely considered a high-income country,[4] of the countries with the 10 highest Human Development Index rankings, Australia has the lowest GDP per capita.[5] I figure it has to be doing some things right and my goal this semester is to learn what some of those successful approaches are.)

So what does Australia do to prevent and address road traffic deaths? And what issues remain?

A study published in Injury, International Journal of the Care of the Injured in 2018 on road traffic injury mortality in 0-14 year-olds in Victoria, Australia sheds some light on Australia’s approach to road safety and remaining challenges. As listed in the study, Victoria’s rate for road traffic injury mortality in children 0-14 years-old is two-times less than the world average. It appears that many strategies enacted over the past decades have proven to be effective in reducing road traffic injury deaths: national seat belt laws, physical separations between pedestrians and motor vehicles, laws about alcohol and driving speeds, etc.[6] (The Public Health Association of Australia lists improved road safety as one of its top public health successes of the past 20 years.)[7] Having grown up in the USA, many of these proven methods for reducing road traffic injuries are commonplace. However, in Haiti, this is not the case.

In the study, there was a variety of interesting insight on the factors related to RTI deaths. What stood out to me the most was that while the rural areas made up 25% of the regional population, they accounted for 85% of the passenger deaths in RTIs and 65% of pedestrian deaths in RTIs. (This was surprising to me as my initial assumption was that there would be more injuries/deaths in urban areas that have higher populations of people and cars). When further examining the data, it turns out that the leading factor for pedestrian RTI fatalities was simply trying to cross the road (44 of 60 deaths). Of these 44 cases, 29(66%) were in rural areas. The 2nd leading factor was walking without supervision (39 of 60 deaths), of which 24(62%) were in rural areas.[6]

The authors of the study discussed promising strategies that could further reduce RTI deaths, many of which appear to be based on costly artificial intelligence technologies. However, little attention was put on addressing the disproportionate representation of RTI deaths in rural areas. I believe this misrepresentation merits further investigation.

When looking at it from a planetary health perspective, one must ask what direct and indirect factors lead to this disproportionate representation of RTI deaths in rural areas? Are children in rural areas educated differently about road safety than in urban areas? Are driving rules and styles different in rural areas? Are road design and location, along with rural community planning an issue?

These questions reminded me of some insight I was once given by one of my mentors in Haiti, a doctor providing medical care in rural areas. He said that when they improved the road in one particular rural area, permitting vehicles to travel faster, there were more road traffic injuries. The behaviors of the local population, which had been used to slow-moving vehicles, did not mix well with the new driving style used on the newly improved roads.

It is important to note that the authors of the study under review stated that overseas immigration is the leading cause of population growth in the Victoria area. Is this having an effect on RTIs? Do overseas immigrants tend to settle in rural or metropolitan areas? Are new immigrants unfamiliar with the driving norms in Australia? How have RTIs changed with the changing population? Furthermore, what factors are driving this immigration?

When looking from a planetary health point of view, I feel that I may have created more questions than answers. Certainly, more than what can be resolved in a single Blog post. But if I could leave myself and others with key takeaway messages, they would be this:

First, examining issues through a planetary health lens can provide additional, meaningful insight in trying address public health issues.

Second, make sure that your children and the children in your community look both ways before crossing the street!

 

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Citations:

[1] Worldometer.info (2020) Countries in the world by population (2020). Available at: https://www.worldometers.info/world-population/population-by-country/ (Accessed Oct. 11^th, 2020).

[2] Global Change Data Lab: Our World in Data (2020) Number of deaths by cause, Haiti, 2017. Available at: https://ourworldindata.org/grapher/annual-number-of-deaths-by-cause?country=~HTI (Accessed Oct. 10^th 2020).

[3] Global Change Data Lab: Our World in Data (2020) Number of deaths by cause, Australia, 2017. Available at: https://ourworldindata.org/grapher/annual-number-of-deaths-by-cause?country=~AUS (Accessed Oct. 10^th 2020).

[4] The World Bank (2020) Australia. Available at: https://data.worldbank.org/country/australia?view=chart (Accessed Oct. 8^th, 2020).

[5] United Nations Development Programme (2019) 2019 Human Development Index Ranking. Available at:  http://hdr.undp.org/en/content/2019-human-development-index-ranking (Accessed Oct. 8^th, 2020).

[6] Chang, S.S.M. (2018) “Child road traffic injury mortality in Victoria, Australia (0-14 years), the need for targeted action”, Injury, International Journal of the Care of the Injured, 49, p604-612. Available at: https://www.injuryjournal.com/article/S0020-1383(17)30906-3/fulltext (Accessed: Oct. 10^th, 2020).

[7] Public Health Association of Australia (2018) Top 10 public health successes over the last 20 years. Available at: https://www.phaa.net.au/documents/item/3241 (Accessed: Sept. 27^th, 2020).

 

Photo credits:

[Feature] The Advertiser (2015) After a horror road toll, it’s time to cut speed limits on rural roads, government says. Available at: https://www.adelaidenow.com.au/news/south-australia/after-a-horror-road-toll-its-time-to-cut-speed-limits-on-rural-roads-government-says/news-story/815e7a033fb1d0f0489bda7a9c105640 (Accessed: Oct. 10th, 2020)

[In-blog] Australian Broadcasting Corporation (2020) Fatal accidents on rural roads continue to galvanise Lara Jensen’s 20-year fight for better road signage. Available at: https://www.abc.net.au/news/2020-06-30/family-continues-to-fight-for-better-road-signage/12395528 (Accessed: Oct. 10th, 2020).

Oct 10, 2020