Road safety issues in China: Understanding key risk factors to improve public health and safety. Dr Judy Fleiter Postdoctoral Research Fellow

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1 Road safety issues in China: Understanding key risk factors to improve public health and safety Dr Judy Fleiter Postdoctoral Research Fellow Australia China Centre for Public Health, SYSU visit, May 11, 2015

2 Overview Global road safety Road safety in China Behavioural research conducted by CARRS-Q in China Future research priorities

3 Acknowledgements Partner Institutions: Institute of Psychology, Chinese Academy of Science, Beijing (5 months) Zhejiang Police College, Hangzhou, China (2 years) Guangdong Institute of Public Health, Guangdong Province Centre for Disease Control and Prevention (4 months) Yinchuan City Centre for Disease Control and Prevention (4 months) Colleagues: Dr Barry Watson, Dr Mark King, Emeritus Professor Mary Sheehan, Dr George Jia, Dr Alexia Lennon - CARRS-Q (QUT) Professor Shi Kan, - Chinese Academy of Sciences Professor Guan Manquan, Ding Jingyan, Xu Cheng Zhejiang Police College Professor Ma Wenjun Guangdong Institute of Public Health Dr Jing Lei - Yinchuan City Centre for Disease Control and Prevention

4 Acknowledgements Funding Australia s National Health & Medical Research Council Postdoctoral Research Fellowship (Australia-China Exchange) Promote Australia-China road safety research & capacity building ( ) Endeavour Australia Awards Cheung Kong Postgraduate Award 2008 (Fleiter) Prime Minister s Australia Asia Postgraduate Award 2012 (Jia)

5 United Nations Decade of Action for Road Safety ( ) Every year, globally, road crashes: kill 1.3 million people injure million people Aim to reduce road-related trauma save 5 million lives in 10 years by sharing experiences, and introducing effective legislation, enforcement and education World Health Organization, 2009; 2013

6 United Nations Decade of Action for Road Safety ( ) Globally, Road traffic injuries 8 th leading cause of death Leading cause of death of young people % of road deaths & injuries occur in low- & middleincome countries 46% of global road deaths are vulnerable road users pedestrians, cyclists, motorcyclists World Health Organization, 2013

7 In China Scale of road trauma problem difficult to determine: Unlinked reporting systems (police, hospital datasets) Reporting mechanisms vary (e.g., death within 7 days of crash in police records, doesn t follow ICD10 classification) Under-reporting likely Police records indicate ~70,000 fatalities/year with sharp decrease since 2002 Examination of 210 military hospitals shows slow increase since 2002 Analysis of city level data indicates 3 times as many fatalities and up to 5 times as many injuries as reported in official data (Qui et al., 2015) These data similar to WHO estimates

8 In China Road fatalities = leading cause of injury deaths ahead of all natural disasters (including fire, earthquake, and flood) (Ma, et al;, 2012). 25% of total productive years lost from all injuries (Zhou et al., 2003) Road fatalities Males = 76% Majority of road traffic injuries (RTI) occur among young males RTI = one of the top 3 causes of death in people aged 60+ (Zhou et al., 2014) Vulnerable road users = 70 %

9 Vulnerable Road Users, China % of Fatalities 35% 70% 25% 17% 6% 10% 5% 2% Source: 2010 PRC Road Traffic Accident Annual Statistic Report, Traffic Management Bureau of Ministry of Public Security, cited in WHO, 2103 Global Road Safety Status Report.

10 Large population, unprecedented economic growth, rapid motorisation, large number of novice drivers Mixed traffic fleet: pedestrians, non-motorised vehicles, increase in e-bikes (banned in some places), heavy vehicles Large rural > urban migration = unfamiliarity with traffic and traffic rules

11 In Transition

12 Enforcement & Education Road safety legislation relatively new (2004) and still in formative stage Traffic police not well respected & responsible for public education with limited resources Varying levels of traffic law enforcement Traffic laws not well understood by general community Road safety awareness relatively low Non-compliance with traffic laws evident Fleiter et al., 2009; 2011; 2013a,b,c; Jia et al., 2013; Senserrick et al., 2011

13 Behavioural factors Illegal/risky on-road behaviours common & appear normalised Non-use of helmets & seat belts Phone use while driving/riding Over-crowded & overloaded vehicles Drink driving Speeding (main reported cause of crashes in China - estimates of between 50-90% of all crashes Du et al., 2013; Fleiter et al., 2009; Fleiter et al., 2013a,b,c; Jia et al., 2013a,b; Routley et al., 2008

14 Behavioural factors Illegal/risky on-road behaviours common & appear normalised Non-use of helmets & seat belts Phone use while driving/riding Over-crowded & overloaded vehicles Drink driving Speeding 2 risk factors identified by Bloomberg-funded Global Road Safety Program ( ) Dalian & Suzhou Bloomberg Initiative for Global Road Safety (BIGRS) Shanghai, legislative focus Du et al., 2013; Fleiter et al., 2009; Fleiter et al., 2013a,b,c; Jia et al., 2013a,b; Routley et al., 2008

15 CARRS-Q Behavioural Research Speeding CRICOS No J

16 Beijing & Hangzhou Speeding Qualitative & quantitative research with car drivers: Speeding viewed as common, normal, necessary, safe Self-reported usual speeds up to 50% above posted speed limits (link to enforcement tolerance in legislation) Safe speeds reported as up to 20 km/h above posted speed limits Preferred speeds significantly faster than safe speeds Penalties not certain and can be avoided (use of guanxi /networks; arguing with police, convincing police not to issue infringement) Experiences of avoiding detection & punishment encourage future offending Fleiter et al., 2009; Fleiter et al., 2013a,b,c; Fleiter & Watson, 2015

17 CARRS-Q Behavioural Research Speeding Drivers attending re-training program after losing licence Significantly more crashes among newly licensed drivers Mean of 4.6 infringements in previous year (range 2-18, SD=3.8) 62% drink driving offence; 48% speeding offence Identification of most dangerous on-road behaviours by drivers Speeding Drink driving... Phone use while driving, fatigue, non-use of seat belts nominated by very few Reflects enforcement practices by police? Fleiter & Watson, 2015

18 CARRS-Q Behavioural Research Drink Driving

19 Guangzhou & Yinchuan Drink Driving Legislative change in May 2011, Drunk driving criminalised 2 legal blood alcohol concentration limits Drink driving = 20mg-80mg/100 ml Drunk driving = >80mg/100ml Qualitative & quantitative research General drivers Convicted drunk driving offenders in detention Traffic police Jia, 2015; Jia et al., 2013a,b, c

20 CARRS-Q Behavioural Research Drink Driving High awareness in both cities that Drunk driving now a criminal offence Low awareness of legal BAC levels in all samples Only 16 40% reported correct knowledge of legal BACs Knowledge of how to keep BAC below legal limit was extremely low for all, including traffic police Jia, 2015; Jia et al., 2013a,b, c

21 CARRS-Q Behavioural Research Drink Driving Evidence of limited police roadside testing and lack of adequate police resourcing Drivers use many strategies to avoid detection, some endangering police safety AUDIT scores used to assess problematic drinking Higher level of alcohol misuse among convicted drunk driving offenders (both cities). Higher among Yinchuan than Guangzhou offenders 1 st time vs Repeat offenders: significant difference in AUDIT scores in both cities. 1 st time offenders had a significant lower AUDIT scores than recidivists. Indicates problematic alcohol use levels among repeat drink drivers Jia, 2015; Jia et al., 2013a,b, c

22 Future Research Legislation in formative stage penalties not necessarily a deterrent low levels of awareness (e.g. BAC levels) low levels of perceived risk associated with high risk behaviours (e.g. speeding, phone use while driving) Evidence needed to reduce harm Enhance data quality Inform policy development Inform public education campaigns Raise awareness about high risk behaviours Consider culturally-specific issues when introducing countermeasures

23 Thank you for your attention today.

24 References (1) Alcorn, T. (2011). Uncertainty clouds China s road-traffic fatality data. The Lancet, 378, Bhalla, K., Li, Q., Duan, L., Wang, Y., Bishai, D., & Hyder, A. A. (2013). The prevalence of speeding and drink driving in two cities in China: a mid project evaluation of ongoing road safety interventions. Injury, 44, Chen, H., Du, W., & Li, N. (2013). The socioeconomic inequality in traffic-related disability among Chinese adults: the application of concentration index. Accident Analysis & Prevention, 55( ). doi: /j.aap Du, W., Yang, J., Powis, B., Zheng, X., Ozanne-Smith, J., Bilston, L., & Wu, M. (2013). Understanding on-road practices of electric bike riders: An observational study in a developed city of China. Accident Analysis & Prevention, 59C, Feng, Z., Raghuwanshi, R. P., Xu, Z., Huang, D., Zhang, C., & Jin, T. (2010). Electric-bicycle-related injury: a rising traffic injury burden in China. Injury Prevention, 16, Fleiter, J. J., Gao, L., Qiu, C., & Shi, K. (2009). Availability, functionality, and use of seat belts in Beijing taxis prior to the 2008 Beijing Olympic Games. Accident Analysis & Prevention, 41(2), Fleiter, J. J., Watson, B., Lennon, A., King, M. J., & Shi, K. (2009). Speeding in Australia and China: A comparison of the influence of legal sanctions and enforcement practices on car drivers. Paper presented at Australasian Road Safety Research Policing Education Conference, Sydney. Fleiter, J. J., Watson, B., Lennon, A., King, M. J., & Shi, K. (2011). Social influences on drivers in China. Journal of the Australasian College of Road Safety, 22(2), Fleiter, J. J., Guan, M. Q., Xu, C., Ding, J. Y., & Watson, B. (2013a). Alcohol-related driving offences, crashes, and traffic policing strategies in Zhejiang Province, China. Paper presented at 20th International Council on Alcohol, Drugs and Traffic Safety Conference, Brisbane. Fleiter, J. J., Watson, B., Guan, M. Q., Ding, J. Y., & Xu, C. (2013b). Characteristics of Chinese Drivers Attending a Mandatory Training Course Following Licence Suspension. Paper presented at Road Safety on Four Continents, Beijing, China.

25 References (2) Fleiter, J. J., Watson, B., & Lennon, A. (2013c). Awareness of risky behaviour among Chinese drivers. Paper presented at 23rd Canadian Multidisciplinary Road Safety Conference, Montréal, Québec. Fleiter, J.J & Senserrick, T. (2014). Addressing China s road trauma burden and related social policy issues, Under review. Fleiter, J & Watson, B (2015). Addressing the road trauma burden in China: Exploring attitudes, behaviours, risk perceptions and cultural uniqueness, Accident Analysis and Prevention, under review Hu, G., & Baker, S. P. (2012). To examine the effect of China s drunk driving policy, high-quality data are needed - Editorial. Injury Prevention, 18(4), 209. doi: /injuryprev Hyder, A. & Bishai, D. (2012). Road Safety in 10 Countries: A Global OpportunityTraffic Injury Prevention, 13(S1), 1-2. Jia, G., King, M. J., Sheehan, M., Fleiter, J. J., Ma, J., & Zhang, J. (2013a). Baseline study of alcohol dependence among general drivers and drunk driving offenders in Guangzhou, China. Paper presented at Australasian Road Safety, Research, Policing, Education Conference, Brisbane. Jia, G., King, M. J., Sheehan, M., Fleiter, J. J., Ma, W. J., & Zhang, J. Z. (2013b). Knowledge and behaviours of drunk driving offenders in Guangzhou, China. Paper presented at 20th International Council on Alcohol, Drugs and Traffic Safety, Brisbane. Jia, G. (2015). An investigation of the knowledge and practices related to drink driving among Chinese drivers, PhD Thesis, QUT. Li, L., Rani, M., Sang, Y. Y., Lv, G., & Barber, S. L. (2014). Two Decades of Research on Migrant Health in China: A Systematic Review Lessons for Future Inquiry: Working Paper Retrieved from World Health Organization. (2013). Global Status Report on Road Safety 2013: Supporting a Decade of Action. Geneva. Luoma, J., & Sivak, M. (2012). Road-Safety Management in Brazil, Russia, India, and China: Report No. UMTRI Ann Arbor, Michigan, USA: The University of Michigan Transportation Research Institute.

26 References (3). Ma, S., Li, Q., Zhou, M., Duan, L., & Bishai, D. (2012). Road Traffic Injury in China: A Review of National Data Sources. Traffic Injury Prevention, 13(S1), Qiu, J., Zhang, J.-H., Zhang, L., Yao, Y., Yuan, D. F., Shi, J. G.,... Evans, L. (2015). Chinese Traffic Fatalities and Injuries in Police Reports, Hospital Records, and In-Depth Records from One City. Traffic Injury Prevention, 16, Routley, V., Ozanne-Smith, J., Li, D., Yu, M., Wang, J., Zhang, J.,... Qin, Y. (2008). China belting up or down? Seat belt wearing trends in Nanjing and Zhoushan. Accident Analysis & Prevention, 40(6), Senserrick, T., Yu, X., Wei, D., Stevenson, M. R., & Ivers, R. (2011). Development of a supplementary education and training program for novice drivers in China. Journal of the Australasian College of Road Safety, 22(2), World Health Organization. (2009). Global status report on road safety: Time for action. Retrieved from World Health Organization. (2013). Global Status Report on Road Safety 2013: Supporting a Decade of Action. Geneva. Zhou, J. L., Li, Y. H., Wang, Q. K., Pollak, A. N., & Slobogean, G. P. (2014). Status of Road Safety and Injury Burden: China. Journal of Orthopaedic Trauma, 28, S41-S42.