ABSTRACT
There is a significant increase in the number of road traffic accidents (RTA), injuries and deaths in the last decade. Besides, the decade has witnessed a shift in the age pattern of mortality due to RTAs resulting a large number of relatively younger population is injured and killed. In addition, light motor vehicles cause more lives than heavy motor vehicles. Since 2000, there has been continuous increase in deaths of two wheeler users due to RTA and it accounts for the largest share of deaths in 2011. Largely, the vulnerable population is in the prime productive age group and males are more vulnerable to RTA injuries and deaths than females. On the other hand, fault of a driver is by far the most important cause of death due to RTA. Therefore, immediate intervention is called for, since there is no specific policy to mitigate road traffic accidents in India.
Keywords: road traffic accident, vulnerable population, prime productive age group, light motor vehicle, heavy motor vehicle
INTRODUCTION
The magnitude of Road Traffic Accidents (RTAs), related injuries, disabilities and deaths is colossal in India and reflecting increasing trends over the years. India, a developing country and one of the fastest growing economies of the world, has to rely on the transport networks to sustain her growth and development. Roads carries approximately (61%) of goods and (87%) of passengers in India1. Besides, Indian road network system is known as the second largest in the world. Indeed road networks are arteries of development. In addition, India has very density of population which consists of about two-fifth in working age group2. Moreover, the situation becomes more
Vulnerable road users in India: An
assessment of road traffic accidents, injuries and deaths
Bornali Dutta1*, Chandrashekhar1
1 International Institute for Population Sciences (IIPS)
* Corresponding Author: Bornali Dutta, Room No. 15, Old Hostel, IIPS, Govandi Station Road, Deonar, Mumbai, Pin-400088, India Tel: +91 9930898134; Email: [email protected]
appalling when there is limited understanding of traffic rules. These circumstances either in isolation or in combination lead to a heavy increase in the road traffic flow which eventually causes accidents, related injuries, disabilities and even deaths. According to National Crime Record Bureau (NCRB), there are 440,123 reported road accidents in the country3. Precisely, in 2011 alone, there were 1284 injuries and 375 deaths per day due to RTA in India.
Road Traffic Injury (RTI) is recognized as a serious public health challenge around the globe. It is also acknowledged as a development problem. Besides, the RTI is the eighth leading cause of death in the world and is the leading cause of death for young people in the age group 15 to 294. In addition, RTA presents hidden impugn, as the health systems, in general, are least prepared to respond to traffic injuries, particularly in developing countries. The magnitude of the problem can be understood from the fact that in the world, nearly 1.3 million victims of RTA die each year and another 50 to 60 million sustain non-fatal injuries4. Also more than 3000 people die every day due to RTA in the world5. Besides, there is large scale of uneven distribution of RTA injury and death in the world, with 90%
of the RTA death occurs in the low and middle income countries which claim to have less than 50% of the world’s registered vehicles4. The middle income countries have the highest annual road traffic fatality rates, at 20.1 per 100,000, compared to 8.7 and 18.3 in the high and low income countries respectively5. The problem of RTAs and related injuries and deaths are increasing at a fast rate in developing countries, including India, due to rapid motorization and other factors. Also, in the upcoming years RTAs and related injuries
are going to increase and will cause more lives than today. Besides, health policies in India have been biased towards medicinal cares and treatment rather than prevention of RTA. In addition, there is little recognition of the RTA injuries and deaths as a serious public health problem in India. Furthermore, RTIs are estimated to constitute 3.5% of the total disease burden in India, and only 0.1% of all health research published from India and included in Pub-Med in 2002 related to RTI6. In such an environment, it is important to raise the issue of vulnerable population due to RTA at the centre stage of discourse and discussion so that it could be recognized as a serious public health problem and accordingly curative measures could be undertaken.
DATA AND METHODS
The National Crime Records Bureau, which is under the administrative control of the Ministry of Home Affairs, Government of India, is the nodal agency that provides statistics related to RTA injuries and deaths on annual basis. Besides, the data for registered vehicles have been obtained from the Department of Road Transport and Highways, Government of India. Mortality rates due to RTAs per 100,000 individuals have been computed by age group as <15, 15-29, 30-44, 45-59 and 60+ for both sexes. The categorisation of the age groups has been done following the NCRB records. For all calculation purposes, the Census data for the year 2001 has been used as the base year of population, and the same has been projected for each consecutive year from 2002 to 2010 using the SPECTRUM software package. The Census data for the year 2011 has been collected from the Primary Census Abstract (PCA), 2011.
CAUSES OF ROAD TRAFFIC ACCIDENTS To have a comprehensive understanding about the vulnerability of the road users, it is imperative to examine causes of accidents first because it ultimately leads to injuries and even deaths. Moreover, the high socio-economic cost of the injuries and fatalities, occurring due to road accidents, and the need for effective policies for curbing road accidents make it essential to study the causes of road accidents.
Perhaps, keeping this in the mind, the NCRB for the first time in 2011 released the cause of accident data for India. The NCRB has categorised causes of accidents into seven types namely, fault of the driver, fault of the cyclist, fault of the pedestrian, defect in the vehicle, defect in the road condition, weather condition and other causes of accidents. Fault of a motor driver is by far the most important cause of accidents in India. Precisely speaking, drivers are responsible for 385,806 accidents, resulted in 399,911 injuries that have caused 102,620 losses of lives in 2011 only.
Alternatively, three fourth of all accidents and related injuries in 2011 are caused by mistakes of drivers only (Table 1).
Pedestrians are one of the important users of
the roads and their fault is the second most leading cause of accidents, injuries and deaths in India, though their share is much less compared to fault of drivers. All other major causes, that is, fault of the cyclist, defect in vehicle, defect in road condition and weather condition account for 1% to 1.5% of all accidents, injuries and deaths. Other than these defined causes of accidents, there are other causes of accidents that are undefined and thus, come under the category as all other causes of accidents. This category accounts for 15% of all accidents and injured cases and 17% of all deaths. Therefore, it is important to define the all other cause of the accident, since the number of accidents, injuries and deaths are more than six times to the second most important defined cause of accidents.
Road traffic accidental deaths by type of vehicle There is a close relationship between the types of vehicle and RTA and related injuries and deaths. It is generally believed that the lighter the vehicle the lesser the impact will be, and so is the injury and vice versa. This happens because of relative less momentum of the impact at the time of accident. Off course, speed of the vehicle should also not be undermined. Consequently, the role of vehicle type in RTA cannot be ignored. It is also a distinct way to investigate the severity of the vulnerable road users. Therefore, the NCRB has categorised the vehicle type into ten types namely, pedestrians, bicycle rider, two wheelers, car, jeep, tempo/van, three wheeler, bus, truck/lorry and others.
Technically speaking, pedestrians are not type of Table 1. Total Number of Accidents, Injuries and Deaths
and Their Percentage Shares According to Different Types of Causes of RTA in India, 2011.
Source: National Crime Record Bureau (NCRB), 2011
vehicle but, it is included in type of vehicle by the NCRB report, and more importantly they are vital road users.
In India, during the last decade, there have been changes in the pattern of road traffic deaths and types of vehicle associated with it (Table 2). For instance, in 2000, death rates were the highest (41%) when RTA crash was caused by heavy motor vehicle (VHMV) including bus and truck/lorry. This was followed by heavy motor vehicle (HMV) including car, jeep, tempo/van and three wheelers (29%). The crashes which resulted in deaths connected to VHMV have declined by 28% in 2011. However, in many other categories of motor vehicles the death rates have increased from 2000 to 2011. When it comes to specific motor vehicle, two wheelers accounted for the largest share of deaths (22.4
%) due to RTA followed by 19.4% of pedestrians. The proportion of RTA deaths due to two wheelers has increased more than double from the previous figure of 11% in 2000 to 22.4% in 2011. Among the HMV, jeeps are accounted for more than 10% of deaths due to RTA in 2000. However, in 2011, car contributed 10% to all deaths due to RTA followed by jeeps (7%). Interestingly, the proportion of buses and lorries have decreased
considerably from 14.6% and 25.9% in 2000 to 9.1% and 19.4% in 2011 respectively.
Largely, there has no change in patterns of deaths attributed to pedestrians and bicycle riders due to RTA in a span of 12 years.
Vulnerability due to RTA by age and sex
The age distribution of deaths due to RTA has changed considerably from 2001 to 2011.
In the year of 2001, the shape of age distribution curve of death due to RTA was much like an inverted bell-shaped with tapering ends at the lower ages towards the left side of the curve (Figure 1).
This suggested that the mortality because of RTA was very low in the lower age groups and low in the higher age groups. Also the mortality due to RTA was moderately high in the lower middle age groups (15-29), and high in the middle age group (30-34) and very high in the higher middle age groups (45-50) which were 13% and 14% respectively. It is important to note that most of the deaths occur Table 2. Percent Distribution of Share of Deaths Due to
RTA by Vehicle Type in India, 2000-2011.
Source: National Crime Record Bureau (NCRB), 2000-2011
in the productive age groups, that is, 15 to 29, 30 to 44 and 45 to 59, which is considered as economically productive population and plays significant role in the economic development of a country. Of these age groups, the age group comprised of 30 to 44 is the prime productive age group. In 2006, the shape of the mortality curve due to RTA changed on account of the fact that the pattern of the highest death due to RTA shifted from age group 45 to 59 to relatively lower age group which is 30 to 44 (Table 3). Since then, the phenomenon continued till 2011. Thus, the shape of death rate curve due to RTA has become an inverted cone shaped, with again tapering ending at the lower ages. Therefore now the vulnerability of the relatively younger population has increased. This is a major cause of concern since RTA is now taking away lives of the prime productive population. However, the lowest death rate due to RTA remained the same in the age group less than 15 years followed by the higher ages thus, holding the pattern as it was in 2001. The phenomenon has been the same for both sexes over the last twelve years but, in absolute terms the male
mortality is substantially higher than female mortality. Thus, it can be concluded that irrespective of age group, males have greater vulnerability to death due to RTA than females.
There is highly skewed distribution of death rates due to RTA between males and females in India. It seems obvious because the male population relatively use more automobile and are more exposed on roads. Moreover, there is significantly less female work force participation in India. Females in India are by and large confined to household activities. In addition, it is worrying to note that the death rate due to RTA has increased for all ages and for both sexes from 2001 to 2011 though the magnitude is much higher in the case of males.
For instance, there is an increase of ten points in the death rate of males in the age group 30 to 44 from 23 per 100,000 populations to 33 per 100,000 populations from 2001 to 2011 respectively. Similarly, there is an increase in death due to RTA among females but the magnitude is much lesser. Such as, the death rate of females in the age group 30 to 44 is the highest and has increased from 4.4 to 5.5 per 100,000 from 2001 to 2011.
The interesting observation about the female death rate is that the second highest death rate is in the age group 60 and more, which is 5.1 per 100,000 populations. It is noticeable that the share of death rate of economically active population from 15 to 59 years due to RTA is more than three fourth in case of males and about 72% in case of females. Again, the magnitude of the male mortality rates is much Table 3. Deaths Rates in Road Traffic Accidents (RTA)
By Age Groups and Sex in India, 2001-11.
higher than that of female mortality rates at all ages but the pattern of age distribution of the deaths are somewhat the same for both sexes.
DISCUSSIONS AND CONCLUSIONS The last decade has witnessed phenomenal increase in the RTA cases as well as injuries and deaths. This is coupled with unprecedented increase in the number of registered vehicles. According to the NCRB, fault of the driver is by far the most important cause of accidents, injuries and deaths since drivers contribute more than three-fourth of all accidents and injuries. Falling asleep is one of the contributing factors of drivers’ fault. On one hand, it has been found that sleepiness and drowsiness of drivers cause a high number of accidents7. On the other hand, it may be over reported of the fault of motor drives in RTA since there is a tendency among general public to put the blame on the vehicle drivers. In addition, a driver tends to get blamed if a victim is hit by a vehicle. It demands further investigation to arrive at a conclusion. Fault of the pedestrian is the second most important cause of accidents, injuries and deaths, though the magnitude is much less than the fault of the driver and ranges from 2% to 3%. Fault of the cyclist, defect in the vehicle, defect in the road condition and weather condition are other causes which range from 1% to 2%. All other causes of road accident, which includes other than the mentioned causes and are undefined, contribute about 15% of the road accidents and injuries. Here it needs to mention that other cause of death may include death due to environmental condition, road condition, absence of traffic signal etc. these are important factors to mitigate the RTA injuries and death. There is a need to define all other causes of accidents since it is the second most
important cause of death and contribute about seven times more accidents and deaths than accidents caused by fault of pedestrians.
There is a variety of road users, starting from pedestrian and bicycle riders to light and heavy motor vehicle users. The trend of deaths due to RTA for the last twelve years suggests that there is two-fold increase in the death of LMV users. Pedestrians and bicycle riders accounts for more than one-tenth of all deaths due to RTA. If combined together, the pedestrians, bicycle riders and users of motorised two wheelers accounts for one-third of all deaths due to RTA in India. There is a good amount of published works suggesting that the tendency of some of the road users, particularly pedestrians and motorised and non-motorised vehicle users vastly over-represent among accident victims in the world 5, 8. Also, these victims are at higher risk of accident related disabilities9. Study that focuses on India suggests that motorcyclists have especially high rate of injuries and deaths 10, 11. Unlike the bicycle riders and users of motorised two wheelers, the pedestrians are often double exposed to the risk of accident injuries because they are most likely to use the road and the public transport as passengers12. There can be many explanations for the vulnerability of these groups of road users. First, the high fatality of the two wheelers may be ascribed to the fact that people are increasingly using private vehicles for transportation; and there is a high proportion of two-wheeler ownership.
Second, pedestrians, two wheeler riders and bicyclists form a major bulk of road users;
hence their exposure and vulnerability are higher13. Third, distinct from car users, these road users are directly exposed in traffic environments and are thus unprotected.
Fourth, use of helmets is mandatory for all
motorcyclists in India, but people do not often follow the rules. Fifth, there is much lesser awareness about traffic rules among the general population. Last but not the least, there is no India policy regarding the use of helmet and other safety gears. Also, bicycle riders seldom use helmets in India. On the other hand, only New Delhi, Mumbai and Kolkata have mandatory rules to wear helmets for the pillion riders14. As a result, motorcyclists and bicycle users are relatively more exposed to accidents on the road. Therefore, in the event of crash, they come to the direct contact with the impacting vehicle and energy transfer is comparatively higher, resulting into serious injuries and deaths15.
In case of VHMV users, there is a decline in their death in the last decade. This has precisely happened because of considerable decline in deaths due to bus and truck/lorry users from 2000 to 2011. However, in case of HMV, deaths caused by cars have increased by one and a half times, but deaths due to impact of other HMVs like jeeps and tempo/vans have declined in the last decades. In the recent years, the reduction in deaths due to impact of buses is likely caused by an increase in the use of private vehicles, especially two wheelers.
Similarly, the increase in deaths due to impact of cars may be because of increasing use of personal cars in place of public transport and increase in sports utility vehicles (SUV).
The vulnerability of the RTA injuries and deaths are not only limited to the victims itself, but, one of the important repercussions of the RTA is its socio-economic impact on victim and their family. It is established that the RTA causes the most productive age group of population. If a victim is the sole bread winner of his family which is often the case, the whole family suffers from the loss. Even if the victim
is not the bread winner then, also, a significant amount of money is invested for hospitalization costs and other medical and non-medical costs. Otherwise, this money could be used for welfare of the family. It should be noted that the cost of hospitalization for RTI is 2.5 times more than average medical expenditures per hospitalization16. In India, a large number of poor households depend on daily wages and temporary employments;
usually they do not have health insurance or assistance of social welfare scheme. In such circumstances, a serious injury can result in permanent reduction of income and the family may be trapped in complete indebtedness.
Thus, RTA has several ramifications at the societal level. For instance, there is huge psychosocial and economic loses, particularly of children, due to loss of their parents17. Also, the disability occurring due to RTA has many consequences. The permanent disability may lead to lasting unproductiveness. Even if, the disability is for few months then, also temporary unproductiveness takes place. In both cases, there is loss of money, which has other social impacts.
Like other countries of the world, India too has a considerable skewness between males and females in the distribution of death due to RTA. In all ages, male mortality is higher than female mortality, whereas in the working ages, between 15 to 59 years of age, the male mortality due to RTA is exceedingly high as compared to female mortality. Likewise, there are several studies noting that people aged 15 to 44 years account for more than half of the road traffic fatalities18, 8 and almost 70% of potential years of life lost in many countries19,20 Precisely, in 2011, the age group 30 to 44 has the highest mortality rate due to RTA both in the case of males as well as females, but the
magnitude of male mortality rates are six times higher than that of female mortality rates. It is interesting to note that in 2001 road traffic fatality was the highest in the age group 45 to 59 indicating that relatively younger people are killed in the RTA in the recent years. Thus, RTA is causing more productive population of the country than any others. According to the NCRB Report, 2011, the age group 15 to 44, has accounted for nearly two-third (60.7%) of all persons killed in accidents in the nation.
Similarly, all national reports and independent studies irrefutably pointed out that male are injured and killed in a great number, with male to female ratio varying from 4:1 to 5:110, 13, 21. The relatively large magnitude of male fatality due to RTA is explained by the fact that males have greater access to road and vehicles than females. Also the predominance of male mortality might indicate gender differentials in risk taking, exposure to risk, economic opportunities and type of employment22. Similarly, the outnumbered male mortality due to RTA may also be attributed to the fact that females in India are largely confined to household activities and there is also relatively low female autonomy. These factors account to comparatively low vulnerability of females on the Indian roads. Children’s death rate of less than 15 years is 2.6 per 100,000 populations though their share in the total population is 32%. The low fatality of children in India is inquisitive as there is a significant number of children walking and going to school by bicycle unescorted in both urban and rural areas17. Alternatively, it can also be argued that children are taken care of by elders, less likely to use vehicles and also less likely to be exposed on roads23. Thus, further research is needed to find out low vulnerability of children in the RTA to reach at a conclusive stage.
Based on the above discussion, it is clear that the RTA accounts for a large number of injuries, disabilities and deaths. It becomes even more challenging since economically it takes away the most productive part of the population. Also, their vulnerability is affecting the economic development of the country. In addition, the trends and patterns of RTA show that it is going to increase in the upcoming years. Therefore, it is a serious public health challenge in India. Moreover, in the coming decades, the rate of urbanization is going to increase that will increase the number of vehicles and thus the vulnerability of the working population.
POLICY IMPLICATIONS
India currently does not have national injury prevention programme. Most injury prevention is the responsibility of police, transport, and legal sectors with no involvement of the health sector in primary prevention21. Therefore, immediate policy intervention is called for so that the vulnerable working population could be saved. For instance, there should be mandatory helmet laws, seat-belt laws and their strict implementation in all states of India in both urban and rural areas. The productive population is at the risk of RTA, therefore awareness campaign is essential. Aggressive media campaign could prove vital in this direction. Scientific evidence exists for most of these interventions and they only need proper implementation5. Strict implementation of such interventions will certainly reduce the vulnerability of the masses.
ACKNOWLEDGEMENT:
We would like to extend our sincere thanks to Dr. Nobhojit Roy, Dr. Vineet Kumar, Dr.
Monty Khajanchi, Dr. Anita Gadgil and Siddarth David for their inputs, support and encouragement.
DECLARATION OF CONFLICTING INTEREST:
The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.
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