Online newsletter Volume 2, Number 3,  Winter 2004-2005

Learning from Australia

A high-income country’s approach to a low-income fatality rate
 

In highly motorized countries' generally successful record of reducing traffic-crash deaths and injury in the last few decades, Australia stands out. Few countries have experienced as dramatic a decline.

In 1975, Australia’s rate for traffic deaths was 30.4 per 100,000 population, 44 percent above the median for the members in the Organization for Economic Cooperation and Development (OECD), a consortium of 30 countries, generally highly motorized and high-income, who produce two-thirds of the world's goods. Its rate in 1975 was higher even than the average for African countries today, which stands at 28 deaths per 100,000. But by 2003, Australia's crash death rate had dropped to 8.2 per 100,000, below even the average for affluent European countries, which is 11 per 100,000. Australia’s planning and goal-setting strategies, especially those targeting vulnerable road users and indigenous populations, are potential guides for motorizing countries that are just beginning to investigate ways to lower their traffic fatality rates.

It should be noted, however, that certain other of Australia’s strategies, such as lowering speed limits, implementing random breath testing and enacting seat belt laws, are naturally geared toward vehicle drivers and occupants. While such driver-oriented policies can help reduce crash deaths in the less motorized world, care must be taken to make sure the special risks of pedestrians and other non-motorized road users are addressed as well, because they make up the majority of crash fatalities in low- and middle-income countries.

Australia’s response to World Health Day 2004

To mark World Health Day 2004, the Australian government produced a well-designed, readable, 300-plus-page publication describing its National Road Safety Strategy "as a contribution," in the words of Local Government Minister Ian Campbell in his opening message, to World Health Day 2004, and in the belief that it could serve as a guide and spur to raising awareness of the need for greater attention to road safety around the globe. The work of the Australian Transport Safety Bureau (ATSB), it posits that the injuries and deaths from traffic crashes are a disease burden affecting the entire country and details Australia’s current efforts as well as future goals and plans.  "We have made considerable progress since deaths on our roads peaked in the 1970s. Our fatality rates are lower than OECD median rates, but are still not good enough," Campbell wrote.

The report is a reminder of how seriously Australia has taken traffic safety starting in the early 1970s, when the State of Victoria introduced the world's first mandatory seat belt laws. Notable for its clarity and accessibility, Australia’s World Health Day report gives an overview of “road trauma” in Australia, describes how traffic crashes in Australia fit into the global health picture, and details developments and trends in traffic safety. One of the report’s key features is its detailed breakdown of Australia’s national strategy to reduce the number of traffic deaths.

Road deaths increased rapidly in Australia from 1925, when motor vehicles became the dominant form of transport, peaking at 30.4 deaths per 100,000 in 1970. That year, Victoria enacted the first law anywhere to require the wearing of seat belts, with the rest of the nation following suit three years later. Traffic deaths began to level off. Random breath testing and compulsory use of child restraints went into effect in Victoria in 1976, and by the end of the decade the rate of traffic deaths across the country was continuing to drop. It continued to fall rapidly over the next decade, and in 1989 the Australian government introduced a Ten Point Plan for traffic safety that included a national 0.05 blood alcohol concentration limit, national uniform speed limits, enforcement to ensure that one in four drivers is randomly breath tested annually, graduated licensing for young drivers, and compulsory motorcycle and bicycle helmet laws. The first National Road Safety Strategy was introduced in 1992, with an update in 2000, and the first National Road Safety Action Plan was introduced in 1994, with updates in 2001 and 2003. By 2001, Australia’s road death rates for population, motorization, and distance traveled were all below the corresponding OECD median rates.

Rural areas key 

Australia’s strategy in reducing traffic deaths is to set explicit, quantitative goals, the primary one being to reduce the annual number of road deaths per 100,000 people to no more than 5.6 in 2010, a reduction of 40 percent. Working toward this goal requires a high level of interaction among national, state, and local governments and between urban and rural transportation and public health agencies.  

The overall plan identifies several specific areas in which traffic safety can be improved and assigns each a share of the overall reduction. They are: safer roads, i.e., re-engineering intersections and roadways, which is expected to contribute 19 percent; improved vehicle occupant protection, 10 percent; improved road user behavior, 9 percent; and new technology to reduce human error, 2 percent.  

Given that over half of all Australian traffic deaths occur on rural roads, safety programs specifically target the nation's vast rural regions. The phenomenon of a high rural road fatality rate is shared by many other countries, both low- and high-income, including the U.S. (See the Rural Road Safety issue of the TSC newsletter). A striking example is Australia’s least populated state, the Northern Territory, which has fewer than 200,000 people, but has a fatality rate of 26 per 100,000—more than twice that of the next lowest.  

An additional dimension to this problem, both in Australia and the U.S., is the tendency for minority populations (particularly indigenous people in the case of Australia), to be over-represented in rural road crashes. According to the report, “along with diabetes and stroke, road crashes represent a major cause of death for indigenous Australians,” and data suggest that “the number of road deaths involving indigenous Australians is on the rise.” Studies have shown that over 70 percent of indigenous Australians live in non-metropolitan areas and are therefore more exposed to the dangers associated with rural roads such as higher speeds and under-designed and poorly lit roadways. Studies have also shown that indigenous Australians tend to be more involved in crashes characterized by alcohol involvement, overloaded vehicles and failure to use seat belts. This finding suggests that they are not being reached as effectively as the non-indigenous populations, the report notes. A key shortcoming is the lack of  data collection systems that consistently report deaths and injuries happening to indigenous people.  

In terms of what knowledge they do have, safety agencies have responded by establishing community-based safety programs that focus on ways to reduce alcohol-related traffic deaths. The ATSB has also developed a broader list of suggested actions that local jurisdictions can take, including: developing consistent and reliable road safety data, researching historical and cultural factors that influence beliefs and perceptions about health and injury, and legislation to address known risky practices. 

While these policies are being developed further, agencies have gone ahead and created programs tailored to and informed by indigenous communities. They are being implemented, with a heavy reliance on local input and respect for local cultural institutions and norms. Some examples cited in the report:

--The “Kick a Goal for Safety” program. Indigenous police officers present road safety messages to schools and clinics, coupled with locally staffed volunteer civilian night patrols to protect pedestrians and reduce crime.

--A project in remote Western Australia that aims to improve pedestrian safety includes distributing reflective bracelets for pedestrians at night, pedestrian awareness media campaigns, and installing lights on main roads. 

--A New South Wales program helps indigenous car buyers understand their basic consumer rights when purchasing or financing vehicles, with an eye to helping them purchase the safest and best-equipped car or truck for their money.  

The Federal Department of Transport and Regional Services oversees the ATSB, which is the primary traffic safety agency. Its specific functions include: crash investigation, safety data analysis and research, and safety communication and education. However, the responsibility for developing traffic safety programs is vested mainly with states, territories and local governments, rather than Australia’s federal government. This allows local and state governments to develop and implement strategies that reflect their own needs while still coordinating with federal agencies.

Speed and belts and bad roads 

National uniform speed limits were established in 1990 as part of the Ten Point Plan. Speed limits in every region must be set no higher than 110 km/h. This law was followed in 1991-1992 by the introduction of speed cameras in several states and progressive introduction of 50 km/h speed limits in urban residential areas between 1998-2004. The issue of speeding is a particularly pertinent one in this largely rural nation, as rural roads
typically have higher speed limits, and people traveling on them drive faster, consequently increasing the chances of serious injury and death in the event of a crash  

The report includes the rationale for speed management, why and how speed limits are set, why speed affects crash risk and severity, and the results of a survey of Australians’ views on speed limits and speeding. It acknowledges that speed management can be controversial because of long-held assumptions such as slower-moving vehicles are more likely to crash under certain circumstances or that "moderate" speeding may help drivers stay alert. It debunks these and other claims and details how and why speed is a factor in increasing the likelihood that crashes will result in more serious injuries and deaths. Under a section titled "perception versus reality," the report notes that "Personal experience is a poor guide to understanding the links between travel speed and risk." While serious crashes are quite common when considering the entire motoring population, for an individual driver, they are very rare. "[I]t is still quite possible for an individual driver to engage in regular 'moderate' speeding for a long time without disastrous consequences….Therefore, what a great many drivers erroneously learn from personal experience is that 'moderately' fast driving is 'safe.'" 

Victoria became the first jurisdiction in the world to enact a compulsory seat belt law in 1970, and seat belts became compulsory nationwide in 1972. The effect was immediately noticeable. According to the report, “in Melbourne, one month after the legislation was enacted, seat belt wearing rates increased from 25 percent to 50 percent. … After a further one month of enforcement, wearing rates increased to 75 percent.” These laws are credited with helping to reduce Australia’s traffic death rate dramatically. Today in Victoria, the seat belt compliance rate is at 97 percent. Nationwide, it is 90 percent—one of the highest rates in the world—and a 96 percent rate for front seat passengers.  

Another quantitatively oriented campaign is the Road Safety Black Spot Program, initiated in 1990, and running until 1993, and re-introduced in 1996. It works on two principals: it targets locations with a high incidence of crashes involving death or serious injury, and it targets improvements that maximize the number of lives saved per dollar spent. Projects must show at least a 2:1 return on costs in terms of the value of deaths and injuries avoided. (The report has an entire section explaining how monetary values are assigned to traffic victims' suffering.) In keeping with the recognition of the important role of rural crash fatalities, half the Black Spot funds are spent on rural locations. Improvements include roundabouts, traffic signals and shoulder markings at these locations. A 2001 evaluation estimated that it had prevented at least 32 fatalities and more than 1,500 serious crashes in its first three years, with a return on investment greater than 14:1.
 

Protecting the vulnerable 

Pedestrians make up a far smaller proportion of those killed and injured on the road in Australia, some 30%, compared to typical low-income, motorizing countries. Yet the Australian government has taken pedestrian injury and death seriously, acknowledging the threat posed to pedestrians as the most vulnerable road users who are unprotected in the event of a crash. Pedestrian deaths have decreased over the last decade, likely due to the aggressive national traffic safety plans established in the early 1990s, most notably the speed management programs. In fact, the death rate for pedestrians declined more sharply than that of vehicle occupants, and now equals the OECD median rate.  

Some pedestrians, mainly children and older adults, are disproportionately at risk. The report notes that a very small share of pedestrian deaths could be firmly pinned on driver behavior, and that much of the risk stems from the way people in these age groups interact with traffic.  In the case of older people, it is "due to the perceptual, cognitive and physical deterioration associated with aging. Assessments by police and coroners indicate that the primary responsibility for fatal collisions mostly lies with elderly pedestrians. Only a small proportion of the deaths (5 percent) were recorded as being due to risky road use on the part of the vehicle driver.” In addition, the collisions tended to occur in “complex traffic environments," which would be more challenging for people with reduced faculties. Similarly, most fatal child pedestrian crashes are caused by lack of awareness or misjudgment on the part of the child: “In 1999, 28 of 33 pedestrians killed aged 16 years and under were assessed as solely responsible for initiating the crash," the report states. 

Rather than blame the pedestrians, the report suggests these findings support efforts to reduce urban travel speeds. "A detailed study of fatal pedestrian crashes in Adelaide found that 32 percent of pedestrians who died would probably have survived if the vehicle that hit them had been traveling 5 km/h slower; one in ten would not have been hit at all," the report notes. After Victoria introduced intensified speed camera enforcement, along with a large media campaign, pedestrian deaths dropped 42 percent, it noted. Again, the efforts represent a coupling of research, implementation and enforcement, that allows policy to be translated into effective program responses. 

Unlike pedestrian and vehicle occupant deaths, motorcycle deaths have risen over the last decade, and have risen sharply in the last few years. This is a category where Australia, with 6.2 motorcyclist deaths per 10,000 registered vehicles, does not perform as well as the OECD median, which is 3.4. This may be due in part to the increasing popularity of motorcycles, the report notes, especially among older riders. Studies have shown that risk-taking is higher, with speeding and alcohol involvement significant contributors to the motorcycle fatality rate. "Overall, 55 percent of motorcycle riders involved in fatal crashes between 1998 and 1999 were speeding, intoxicated, inappropriately licensed or unlicensed, compared with 27 percent of motor vehicle drivers,” the report notes, adding that these developments suggest a need for new programs to improve motorcycle rider safety. The steps that Australia takes to close this gap in the coming years may serve as useful reference for motorizing countries, which tend to have high numbers of two-wheeled vehicle users.  

Bicyclist deaths have been trending downwards since 1997, despite a large blip upward increase in 2001. The number of cyclist deaths during 2003 was the lowest number since 1950, despite the increase in the popularity of bicycling. Australia was the first country to require helmets of all bicycle riders and continues to examine ways to increase cycling safety. The report notes with concern the high incidence of serious injuries among cyclists, with 65 seriously injured for each death. The report compares their vulnerability to pedestrians and notes that "while there were more than seven times the number of pedestrians killed than cyclists each year, the number of serious injured cyclists and pedestrians is about the same." A high proportion of the seriously injured are children, though there isn't enough data to know whether that is due to children's higher exposure because they tend to bike more. The report said more data were needed.
 

Lessons to be taken away 

While adopting all of Australia’s specific goals and strategies would be impractical for most motorizing countries, lessons can still be learned from its careful planning, quantitatively based interventions, and its melding of engineering, enforcement, and policy. The report provides a detailed description and guide.