276

CAP National Seminar

CHANGINGDIRECTIONSTowards SustainableTransport in Malaysia7-10 September 2001RECSAM, Penang

TOWARDS EFFECTIVE INTERSECTORAL COOPERATIONFOR ROAD SAFETY IN MALAYSIA

by

Dr.R.Krislman, FRCP, FRACGP, FAAMAssociate Professor and DirectorMalaysian Helmet Initiatives

Department of Primary Care MedicineFaculty of MedicineUniversiti Malaya

50603 Kuala Lumpurrajamk(ti{ummc.edu.my

IATI N SAHABA T ALAM MALAYSIA27 Lorang Maktab10250 Pulau Pinang

Malaysia~2 Jalan Macali ter10400 Pulau Pinang

Mal) ia

op right AP, AM and author

277

TOWARDS EFFECTIVE INTERSECTORAL COOPERATIONFOR ROAD SAFETY IN MALAYSIA

Dr.R.Krisllllall, FRCP, FRACGP, FAAM

."~pidemiologists too often overemphasise the personal riskfactors that differentiate between111:Ju~eda~d uninjured people" while neglecting "environmental and circumstances of injury(which) dictate not only who is hurl but also the best means to prevent the injury"(Baker S, 2000)

This paper is adapted from a consultancy report to the Ministry of Health.The views expressed here are those of the author.

INTRODUCTION

Injuries are the third leading cause of death and disability in Malaysia. Injuries are the majorsingle cause of admissions to government hospitals in 1995, excluding normal delivery andcomplications of delivery. (Ministry of Health 1995) Road traffic injuries constitute the mostcommon type of Injury. Since the young are mainly affected, road injuries are the leadingcause of loss of disability-adjusted life years (DALYs). The incidence of road traffic deathsper 100,000 population has increased fromI2~.4 in 1977 to 25.5 in 1999. However, thenumber of road deaths 10,000 vehicles has declined from 15.5 in 1977 to 5.8 in 1999 and islikely to decrease further due to rapid motorisation alone. Road deaths per 10,000 vehiclesmay not be valid indicator of road safety in Malaysia. Road deaths per kilometre travelled isthe best indicator of road safety measures. However it is difficult to estimate this unit. Theeconomic loss due to road traffic injuries in any country, including direct and indirect costs,has been e timated to be about 1-2% of the GOP. (Asian Development Bank 1996) The totalcosts of road traffic injuries and crashes in Malaysia has been estimated by the Road SafetyResearch entre, Universiti Putra Malaysia. (Radin Umar 2000)

PREVENTION OF ROAD TRAFFIC INJURIES

1.1 urveillance of Road Traffic Injuries

Traffi police lie t data on road injuries to determine "fault" and assess damages for bothlegal and in uran purposes. Many minor road crashes (which often does not result ininjurie ) g unrep »ted and are ett~ed ~y the parties ~oncerned .to s~ve th(,mselve~ t~e trou~lef making p Ii e rep rts and making Insurance claims (resulting In loss of their .no claim

di ount "). inc the rep rting of road crashes is mand~tory by I~w all crashes which resultin fatal, ri u and minor injurie are captured by the police recording systems.

Th P Ii ' datainf rrnati n n u

v ry u cful to de cribe the ~pi?emiology of road injuries. Howev~r,f pr t ti e cquipment by victims (such as helmets, seat belts, child

278restraints, etc.), study of other risk factors e.g. speed of involved vehicle, use of alcohol/drugsand correlation with nature of injuries is not complete. It may be difficult to assess the use ofprotective equipment or misuse of alcohol/drug in a crash scene. Two earlier studies on roleof alcohol in road crashes suggest that alcohol may playa role but the exact magnitude of theproblem of drunken driving and role of alcohol could not be assessed in both studies formethodological reasons. (Shahrom, 1991, Ishak, 1999) Hence, this kind of informationshould be obtained by specific research. Similarly, information on nature of vehicle and type /severity / frequency of injuries is available in the police database but is not analysed andreported for ordinary use.

Currently, the traffic police spend a significant proportion of their resources in receiving andanalysing all crashes reported to them. As mentioned earlier, a considerable proportion ofcrashes do not result in injuries but are reported for vehicle damage claims as per insurancepurposes. If minor crashes (those not resulting in injury) are referred directly to the insurancesector and not to traffic police, this additional time and resources saved could be reallocatedto investigation of moderate / severe crashes and, more importantly, enforcement of existingtraffic rules / mandatory use of protective equipment and education of the public. Thegovernment should consider enacting that insurance claims involving only vehicle damageneed to be investigated by the insurance sector.

1.2 Education of the Public about Road Injury Prevention

1.2.1 The evidence

There has been considerable amount of recent evidence describing educational strategies thathave been successful in reducing road traffic injuries (Svanstrom, 2000). A variety ofstrategies from multisectoral targeted campaigns, community and clinic based programs havebeen implemented. These interventions have been described mainly from developed countrieswhere the epidemiology of road injuries is different than that in developing countries. Indeveloped countries, vehicle drivers constitute the majority of road fatalities while indeveloping countries like Malaysia, the vulnerable road users (motorcyclists, pedestrians andbicyclists) constitute the majority of road fatalities.

The following are some of the educational measures which have been proven to beeffective in prevention of iujurie to road users: (Svanstrom, 2000,http://depts. washington.edu/hiprc!ch ildiniury/,)

• Motorcyclists - proper use of full faced helmet of acceptable quality• Bicyclists - proper use of helmets of acceptable quality• In both in tances, head injurie are the leading cau e of death and permanentdisability• Vehicle occupants - usage of restraint ystem and airbags (The risk of injury ireduced with proper use of th e protective device )

2

Examples of strategies (in other sectors) that have been proven to be effective:

., Pedestrians - reduction of speeds of vehicle (The severity of injury and death IS

directly proportional to the speed of the vehicle at impact)• Reduction in speed limits,• Sa~er vehicles by use of side impact systems, enclosed vehicle concept,• Strict enforcement of alcohol limits in drivers

There is little reliable evidence to show that the following programs result in ed ti. " . r uc IonlD mjuries: (Svanstrom, 2000, http://depts.washington.edu/hiprc/childinjuryl)

Motorcycle and bicycle rider education on riding techniquesCar driver education on defensive drivingTeaching young children to cross roads

1.2.2 Current Experience III Malaysia

Motorcycle helmet use

In 199415, University of Malaya carried out a study motorcycle helmet use in urban and ruralareas for the Road Safety Council of Malaysia. The study was carried out with thecooperation of the traffic police in different parts of the country. The studies showed that asignificant proportion of motorcyclists in urban and rural areas either did not wear helmets orstrapped the helmets loose or not at all (Krishnan, 1995). Between 1996 and 1998, theCouncil launched a multimedia campaign to educate the public about the proper use ofmotorcycle helmets. The University of Malaya then repeated the study of helmet lise in urbanareas of Kulim in 1997. There was no difference in helmet use before and after the campaign.(Hari f Fad.li lah, 1998)

Occupant restraint use

Two tudies of vehicle occupant use in Petaling Jaya 1 Banting and Universiti Malayashowed that a ignificant proportion of Malaysian vehicle drivers and front seat passengersdo not wear their eat belts properly though mandatory by law (Lee, 1996; Lee, 2000).Pa engers in the rear eat were also not aware of the importance of seat belts and childre traint . The u e of child restraints is encouraged by the Automobile Association ofMalay ia which ell a well as hires them to pare.nts. It als_ooffers tec};.n~cal advice on thef .ing f the e eat to its members. These child restraints are ecru fled to Malaysiantandard \\ hile orne of those sold in the open market are not made to any standards. Childre traint are relative! expensive because the certified ones 'arc imported and tax is imposed

the government. nether important issue is the fact that only two or three (with somedifficult) hild re traint can be fixed in the rear seats of cars. The larger vans may be ablet 41 III date additional numb r of child restraints.

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Bicycle helmet programmes

In Malaysia, bicycle helmets were practically unheard of and not worn by bicyclists except inracing activities. Over the last decade, bicycle helmet initiatives were undertaken by theMalaysian Helmet Initiatives, a consortium of organizations and which has been recognisedby the World Health Organisation as a Cooperative Helmet Initiative Program (WHO -CHIP). The program was implemented in different parts of the country with the cooperationof the Ministry of Health, Road Safety Council, Ministry of Education, Royal MalaysiaPolice, Road Transport Department and many other agencies at district and state levels. It is aexample of intersectoral cooperation at the local level. The program was targeted mainly atschool children and at short to intermediate term (about 6months to 1 year) follow upassessment, a significant proportion of children continue to wear the helmets. Details areavailable in http://www.geocities.com/HotSpringslResortl7200/index.html. Problems with theuse of helmets included lack of support by peers, non existent storage space in schools,exorbitant price, etc. These issues are being addressed and continuing support of relevantagencies is needed.

Road safety campaigns

In Malaysia, the Road Safety Council had carried out multimedia campaigns in the past. Inthe initial years, the campaign was not focussed e.g. "Hati-hati di Jalan Raya"(Take care onthe roads). Subsequently, the campaigns were more focussed and targeted (e.g. alcohol andDriving, Motorcycle helmet use, etc). Elliott has analysed the issue of effectiveness of roadsafety media campaigns (Elliott, 1989 ). In summary, most such campaigns in the worldhave been unsuccessful. The main reason is that campaigns increase sensitivity of the publicto the issue at hand and does not result in behaviour change. If, on the other hand, the publicperceive that enforcement is being carried out at the same time, behaviour change is morelikely. The other main problem of "campaigns" is that by definition the time frame isdelineated and sustainability is an issue. A longer term and well planned multifaceted"program" where media education is combined with community participation on a wide scaleis more likely to be met with success. A classic example of a successful campaign whichincluded well researched multisectoral education and concomitant enforcement is theVictorian campaign in Australia pertaining to use of alcohol or use of protective devices or

speed limits.

1.2.3 Community based injury prevention programs

In principle, all community based programs should involve many sectors and should beundertaken by agencies at gras root level. Experience worldwide ha shown whenevercommunities have "owner hip" of program, they are more likely to succeed and besustainable than when programs are top d wn. Adequate resource allocation i a prerequisite.Community based programs need to follow a PREC DE I PROCEDE model (Green, 1991)or "(health) ystems" (lDRC, 1991) r an He oepidemiology"approach ( chwartz et al., )999)which take into account cultural, econ mic and other loft" cietal chara teristic whileimplementing b haviour chang .

4

28

2. INTERSECTORAL COOPERATION FOR ROAD SAFETY

2.1 Current situation

The Road S~fety COl!ncil is.a.registered so~iety, which.is based in the Ministry of Transport.The. patro~ IS the ~r~me Minister who chairs the ~abInet Committee on Road Safety. TheChairman IS the Minister of Transport and Co-Chairman, the Deputy Minister. The Councilhas. about !0.0. memb~rs and has an Executive ~ommittee .. The Council meets annually toreview activines of ItS members. The Council works with the private sector and non-government agencies in promoting road safety education of the public. There is an urgentneed to effectively co-ordinate all road safety policies and activities as well as to restructurethe large number of Council members. An example of an intersectoral road safety initiative atthe district level is a workshop held in Kulim, Kedah on 24th November 1998, whichdiscussed relevant issues and recommended measures. (Appendix I)

2.2 Models of Road Safety Agencies Worldwide

There are different types of road safety agencies exists in different parts of the world.(Krishnan, 1994) Basically, there are three different models. In the first model, a road safetycoordinating committee of officials exists but each agency/ministry involved remainsentirely responsible for its activities from policy making to implementation. The advantage ofthis model is the power to take action but interministry rivalry is a problem and wider roadsafety interest is not represented. In the second model, a central coordinating agency existsfor policy making and planning but acts through other agencies who mayor may not becompletely involved in the policy making process. While independent in principle, thisagency may act only as an advisory body in reality since implementation of policy andprograms i through relevant agencies. The third model consists of a national body consistingof key government decision-makers includes the private, professional and non-governmentbodie . Thi agency needs secure funding and a secretariat.

The World Health Organisation Report on "New approaches to Road Safety" recommendedthat road afety comes under the purvie,: of t~e highest pol~tical. authority withrepre entative from relevant sectors. Th~ baSIS o~ t~IS recomme~da~lon IS the experience\ orldwide that road safety agencies which are within the organisational structure of thehighes t political agency e.g. Prime Minister's Department are gen~r~lly .more eff~ctive thanthose \ ithin a particular sector e.g. Transport. In J~pan, the Intennl~lstenal Council on R~adafet i chaired by the Prime Minister. It has achieved a level of Inters~ctoral co-operation

to over ee implementation of effective five year road safety plans (Kanzaki, 1991).

2.3 Recommendation for Malaysia

I, II' R d f t A 'ell y needs to be set up in Malaysia to plan and implement wellu ume coa a e y g . .hd d t d Ian The agency hould establish regional and local centres/

r _ 'arc c an targ e p .c mrnittees t dinate acti itie at these levels. The agency needs to be supported by full

tim r arch rs.

5

)

"

3 NEED FOR ROAD SAFETY RESEARCH

3.1 Introduction to road safety research

Road safety research is the scientific and objective study of road and traffic systems with theobjective of reducing the suffering and losses due to road crashes. Its three specific purposesinclude the greater understanding of causes and problem areas, development ofcountermeasures and the evaluation of the effectiveness of these counter measures. One ofthe major reasons for the success of road safety in countries like Australia and Sweden hasbeen the research carried out by these agencies before implementing any specific action ormeasure. The enormous number of scientific papers and presentations at internationalconferences from these countries is testimony to this fact.

3.2 Current situation in Malaysia

In Malaysia, road safety research is currently being carried out by relevant governmentagencies like the Jabatan Kerja Raya, Highway Planning Unit, and Universities especiallyUniversiti Putra Malaysia, Universiti Technology Malaysia, Universiti Malaya and UniversitiKebangsaan Malaysia. Special mention must be made of the contributions made by the RoadSafety Research Centre in Universiti Putra Malaysia. This centre was funded by thegovernment through the Intensification of Research in Priority Areas (IRPA) scheme of theMinistry of Science, Technology and Environment and through consultancy projects of theMinistry of Transport. The Malaysian Helmet Initiatives is a consortium of governmentagencies and the Universities and has been active in the field of motorcycle and bicycleinjury prevention research including helmet promotion. It was funded by the IRPA scheme.Vehicle safety research is being carried out by the Automative R&D Group of UniversitiTechnology Malaysia in the Skudai campus and is partly funded by the automobile industry.

General observations on road safety research carried out in Malaysia show that:

a) research has been often driven by committed individuals as in the Road afetyResearch Centre in UPMb) areas of research were often decided by investigators ba ed on their expertise/interestc) some areas were more often re earched than others. Hence, at least initially,"engineering" aspects were more often looked into than either enforcement educational, orpolicy aspects. This can be partly explained by the availability of 'engineering" basedinstitutions like IKRAM, Highway Planning Unit, UPM.d) there is lack of co-ordination between re earcher

It cannot be denied that re earch i be t carried out by individuals committed to their field, inenvironments independent of bureaucratic pre ure and which offer uitable "r ward"structure (as in promotions in Univer ity or a re earch In titute). However there i a need tobalance interest of the nation and tho e of re earchers.

283

3.3 Recommendations for road safety research in Malaysia

Road safety research (and other safety research as well) should be governed by th c II .h " d' . e 10 OWIng

C aracterisncs an directions:

(a). a critical review of all research previously conducted by all relevant agencies becarried out(b) driven by national needs and priorities(c). research function should be independent of executive function though liaison shouldexrsts and centrally coordinated (Trinca, 1988)(d) lead by committed individuals(e) intersectoral and interdisciplinary in nature (including crash and injury data, roads,vehicles, road users)(f) attract the best researchers from all Universities I Research Institutions(g) be subjected to outside peer review of program content(h) carried out on a full time basis rather than on a part time basis(i) funded commensurate to the magnitude of the problem0) a proportion of funds be available to bodies outside the lead agency(k) provide inbuilt career I reward structure(I) linkages should be established with other similar agencies around the world(m) findings should be disseminated to stake holders(n) evaluated by its ability to influence policy I program and not by the number of papersof its investigators" (lORe, 1991)

3.4 Funding for road safety research in Malaysia

The government should be the main sources of road safety research funding (an investmentrather than cost). However, other sources should include the automobile manufacturers,insurance sector, consumer bodies, voluntary organisations, professional bodies, etc.

Ju t as Palm Oil Research Institute of Malaysia (PORIM) exists for a national commodity, a afull time road safety research institute is justified in view of the economic loss in GNP due toroad cra he .

3.5 Priority Areas for Research in Injury Prevention

Link between p lice and medical data to identify to preventable risk factors

a. M t r ) Ie I bicy Ie injuries and use of helmets . .b. V hicle ccupant Injuries and use of seat belts I chd~ restr~mts .c. lnjurie and al ohol / drug use especially in commercial vehicle drivers

n audit f medical sere ning guidelines for licensing of.comm~rcial ve~icle drivers . .Ih ugh rn t r . I helmet law' are in place, compitance IS unsatisfactory. Qualitativer . ar h rna be useful in this area. .

aluati n fpil t interv nti n program targeted ~t youn.g.motorcyclistsPcd tri: n injuri 'i \\ ith respe ttl cati n, pede tnan facilities

7

Studies ofroad crashes and injuries during festive seasons

REFERENCESAsian Development Bank, Road Safety Guidelines for the Asian and Pacific Region, 1996

Baker S (2000). Where Have We Been and Where are We Going With Injury Control. In :Injury Prevention and Control, Mohan 0, Tiwari G.Taylor and Francis (eds.), 19 - 26

Elliott, B. (1989) Effective Road Safety Campaigns: A practical handbook, FORS, Canberra.ACT, CR80.

Green L, Kreuter M. Health promotion planning: an educational and environmental approach.Mountain View: Mayfield 1991

IDRC, WHO 1991. Health Systems Research Training Series. Volumes 1-5

Harif Fadzilah Che Hashim, Abdul Samad, Cheng Ooi Tim. Program Mendidik danMenyedarkan Penunggang-Penunggang Motosikal Tentang Cara Pengguna Topi LeledarYang Betul DiDaerah Kulim, Kedah Darul Aman, Annual Meeting, Road Safety Council ofMalaysia, 1998

Ishak J. Alcohol use amongst patients with mild to moderate road injuries, Master of FamilyMedicine dissertation, Universiti Malaya, 1999.

Kanzaki H et aI, Trends in Traffic Accidents and Safety Measures in Japan, Proceedings ofthe National Road Safety Seminar, Japan International Cooperation Agency, Ministry ofWorks, Kuala Lumpur, 1991.

Krishnan R. "Prevention of Motorcycle Injuries in Malaysia", Annual Meeting, Road SafetyCouncil of Malaysia, Langkawi, June 95

Krishnan R. The national road safety agenda. In : Injury Control and afety, R. Krishnan etal. (eds.) Malaysian Medical Association, 1994,57 - 63

Lee CK et al. A Study of the Usage of Car Occupant Restraint in Universiti Malaya Fir tYear Elective Program, Faculty of Medicine, Univer iti Malaya. 2000

Lee LK. A Study of the Use of Car Occupant Restraint in elangor. Univer ity of MalayaMaster of Public Health Dissertation 1996

Ministry of Health, au e of admi ion t Gov rnment Ho pital , 1995

Mini try of Health. pidemiol gy f Injury in Malay ia. 1997

285

PDM (1999). "Laporan Perangkaan Kecelakaan Jalanraya Malaysia" 1998 (StatisticalReport Road Crash). Cawangan Trafik, Ibu Pejabat Polis, Bukit Aman, Kuala Lumpur.Kuala Lumpur: Percetakan Nasional Malaysia Berhad.

PDM (1998). "Laporan Perangkaan Kecelakaan Jalanraya Malaysia" 1997 (StatisticalReport Road Crash). Cawangan Trafik, Ibu Pejabat Polis, Bukit Arnan, Kuala Lumpur.Kuala Lumpur: Percetakan Nasional Malaysia Berhad.

Radin Umar Radin Sohadi. Research Reports, Road Safety Council of Malaysia, 2000

Schwartz S, Susser E, Susser M. A Future for Epidemiology? American Review of PublicHealth 1999,20: 15-33

Shahrom AW, Mohd Azman AB, Hasnah H, Mohd Yusof M. Alcohol and fatal road trafficaccidents in Kuala Lumpur: a preliminary study. The Family Physician, April 1991,3 :28-29

Trinca GW et aI, Reducing Traffic Injury, A Global Challenge. Royal Australian College ofSurgeons, 1988

Web References and Resources

http://depts.washington.edulhiprc/childinjury/ detailed resource site of the HarbourviewInjury Prevention and Research Centre, Seattle, USA with links to other sites

(http://www.aap.org/family/tippintr.htm) site of the American Academy of Pediatricscontaining details of The Injury Prevention Program (TIPP)

http://www.geocities.com/HotSprings/ResOJ117200/index.htl11l. Web site of the MalaysianHelmet Initiatives

Road afety agencies worldwide

J) weden- http://www.vti.se/omvti!eomvti.asp2) U A --- HTSA - http://www.nhtsa.dot.gov/3) K - TRL __ http://www.trl.co.uklpen.htm

PPENDI

d. fan lntersectoral district level road safety workshop heldApp ndi I - Re ommen auons 0

n 24th November 1998

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