Car trouble

Documenting the scale and nature of traffic injury in Pacific Island nations will suggest ways to minimise death on the roads.

Think of an entire small family clinging on to the back of a motorbike in Thailand or a truck bombing along in India, overloaded with goods, livestock and a mass of people hanging on for dear life, says epidemiologist Rod Jackson, and you get some idea of why road traffic injuries are such a leading cause of death and disability in poorer nations.

Professor Jackson, based at the University of Auckland in New Zealand, is one of the lead researchers behind a new Wellcome Trust research project, funded in partnership with New Zealand Health Research Council, which will help to establish the incidence of road traffic injuries in Pacific nations, starting with Fiji, and - with luck - find ways to minimise the death toll.

These nations have among the highest traffic-related death tolls in the world: shockingly, most rank it among the top five causes of mortality. Furthermore, the majority of crashes affect young adults of working age and cost these nations up to an estimated 2 per cent of gross domestic product annually.

Injuries sustained in road accidents have traditionally received less attention than non-communicable diseases such as diabetes or heart disease. This is despite the sobering fact that these road collisions are the most common cause of death from injury and the ninth leading cause of total deaths worldwide. In 2000 alone 1.26 million people were killed in traffic accidents. However, according to Professor Jackson and his team, these accidents may be just as predictable and preventable as diabetes and other more high-profile afflictions.

"Contrary to popular belief…road traffic injuries are largely preventable," says Professor Jackson, citing the enormous variability in traffic accidents in different regions and at different times. The World Health Organization estimates that 24 per cent of traffic accident deaths worldwide occur in the Western Pacific region, compared with just 10 per cent of the total in far more populous Europe.

If the factors that make accidents more likely can be established, he adds, then the best ways of preventing them can be identified. Solutions can be as simple as making vehicles more visible or creating adequate pedestrian crossings, though these measures vary in effectiveness from region to region, depending on traffic dynamics, says Professor Jackson. For example, the proportion of motorbikes, trucks, bicycles and cars differs widely between India and the UK.

Evidence

The problem of traffic injury in the Pacific is exacerbated by a dearth of precise data. This is where Professor Jackson's project, co-chaired by Sitaleki Finau, head of the School of Public Health and Primary Care at the Fiji School of Medicine in Suva, comes in. Professors Jackson and Finau's research project is one of the 11 successful proposals funded through the Wellcome Trust's Asia-Pacific initiative, a partnership with the Health Research Council of New Zealand and the National Health and Medical Research Council of Australia set up to encourage collaboration between Australia and/or New Zealand and the resource-poor nations of South East Asia and the Pacific.

"In large countries, like China or India, we're starting to get a better idea of what exactly the problem [of traffic-related injury] is," says Shanthi Ameratunga, the project's senior researcher working with Professor Jackson at the University of Auckland. "However, in small island nations, the same issues exist, but we don't have the high numbers that scream out at the wider world."

Luckily, New Zealand has the resources to assist and a long history of working with Pacific nations. Six per cent of New Zealand's population is Pacific in origin, so many issues important in the Pacific are important there too. Some Pacific groups now have more representatives living in New Zealand than at home: 47 000 ethnic Cook Islanders now call New Zealand home, while there are just 18 000 on the Cook Islands themselves.

"The governments of these nations are telling us that they need reliable information, before they can even think about starting to tackle the problem," says Dr Ameratunga. The first step will be for the team to set up a traffic injury 'trauma register' in Fiji (the region's largest nation with a population of 825 000). Fijian colleagues will collect data, from hospitals and other sources, on traffic-related injury and mortality rates. Finding the biggest data gaps is a priority, says Dr Ameratunga. Training Fijians to maintain comprehensive registers for themselves following the current three-year project will be an important component of the research.

Determining which risk factors are most highly correlated with traffic accidents will be the next step. With the help of the authorities, the team will also use roadside surveys to anonymously collect data from drivers flagged down at roadblocks to compare with information collected from drivers involved in crashes. This might include information on the state or repair of vehicles, the quality of roads they are driving on, seat belt use, alcohol consumption and other risk factors that could help explain the high rate of traffic collisions. Such comparisons will allow Professor Jackson and his colleagues to tease out which key ingredients put people most at risk.

At this stage funding allows the project to be fully implemented only in Fiji, points out Dr Finau. Trauma registers will also be set up in the islands of Samoa (170 000 people) and the Republic of Palau (19 000 people), and he hopes to secure further support to complete the projects there. Data from the three tiny nations would allow a comparison across the major ethnic groups of the Pacific: Melanesians in Fiji, Polynesians in Samoa and Micronesians in Palau.

The project will also have indirect benefits, says Dr Finau, as the partnership with New Zealand is helping to develop the Pacific region's research base. "[We will] train researchers from the Pacific to do similar studies in other countries, and to continue the work in participating countries," he notes. "Research by Pacificans for Pacificans."

Informing policy

The final step will be to work with policy makers in each community to develop a plan for minimising traffic accidents. "Most of the time when people think of preventing injuries, they think 'what could the victim have done'," says Dr Ameratunga. "In fact you can also work with the vehicle and the environment." Making vehicles and pedestrian crossings more visible and improving road surface quality are likely to be part of the solution. Anecdotal evidence suggests that the engineering quality of some buses is not up scratch, so that may also be something for local governments to tackle too.

But there is still room for surprises. A study co-authored by Professor Jackson, Dr Ameratunga and others, published in a December 2003 edition of the British Medical Journal, showed that car colour can make a big difference to the likelihood of collision, probably because of differences in visibility. That study showed that silver cars are a staggering 50 per cent less likely to be involved in collisions than white, yellow, red, grey, blue and other colour cars. That doesn't mean that all Pacific islanders should paint their cars silver, but adding simple reflective strips could be enough to make a big difference.

Other steps, designed to make routes to school safer (such as road calming measures), may enhance existing programmes which largely focus on teaching children about road safety, says Professor Jackson. "The major reasons [for collisions] in the pacific are at this stage unknown," he concludes, "and that's what we aim to find out."

External links

Car colour and risk of car crash injury: population based case control study, BMJ 327: 1455-1456 (20 December 2003)
University of Auckland in New Zealand
Health Research Council of New Zealand
National Health and Medical Research Council of Australia

Car trouble

Evidence

Informing policy

External links

Further reading