Website: DEVELOPMENT OF GLOBAL TARGETS FOR ROAD SAFETY RISK FACTORS AND SERVICE DELIVERY MECHANISMS

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1 MINISTRY OF HEALTH RKA BUILDING, GRENADA WAY BARBADOS AVENUE GRENADA CRESCENT 10 A CHELSEA AVENUE KINGSTON 5, JAMAICA, W.I. Tel: (876) /7433/7771/8172 ANY REPLY OR SUBSEQUENT REFERENCE SHOULD BE ADDRESSED TO THE PERMANENT SECRETARY AND THE FOLLOWING REFERENCE QUOTED: REF NO: Website: 28 Novemeber 2016 RE: DEVELOPMENT OF GLOBAL TARGETS FOR ROAD SAFETY RISK FACTORS AND SERVICE DELIVERY MECHANISMS We would like to commend the World Health Organisation on embarking on the establishments of voluntary global targets for road safety risk factors and service delivery mechanisms.. The process is duly noted as a series of consultations towards this end. This is an important public health issues for Jamaica. Please see comments below: The proposed targets and indicators are supported except Target: eliminate production of substandard new vehicles on Page 7 as Jamaica and several other countries do not produce vehicles. Please see grid attached To meet some of the proposed targets significant investments will be required for the programme. The timeline for achieving the targets not clearly articulated. Country example would have been useful to strengthen justification for indicators and targets. The ability to report on targets is a concern using country survey and examples should be provided as to countries that have used this approach. Minister of Health - Dr. the Hon. Christopher Tufton, MP Permanent Secretary Mrs. Elaine Foster Allen

2 Table 1: Review of proposed global voluntary global targets for road safety risk factors and service delivery mechanisms Target/Criteria Eliminate production of substandard new vehicles 100% of new vehicles (defined as produced or sold) meeting 4 priority UN regulations Eliminate high risk roads 100% of new roads are 3 star or better for all road users. > 75% of travel on existing roads are 3 star or better for all road users. Reduce speed the proportion of vehicles travelling at beyond the posted speed limit by at least 10% per year Reduce the proportion of unhelmeted motorcycle riders by at least 10% per year or at least 90% helmet wearing. Reduce the proportion of High epidemiologic and public health relevance Important and relevant. Important and relevant. Evidence driven target and indicator Availability of effective and feasible public Health interventions Ease of communication (simplicity) Recommendation Yes Yes Not relevant for countries that do not produce new vehicles. Not recommended Yes - Yes Recommended. Should include target for old vehicles as most developing nations would have old vehicles. There is a large used car market. Yes Yes Yes Yes Recommended Yes Yes Yes Yes Ambitious target which may not be attainable. A target of > 50% is recommended. Yes Yes Yes, but will be challenging to implement and will require significant investment in infrastructure and health promotion. Yes Recommend. A concern as to how this will be measured via country survey. Yes Yes Yes Yes Recommend Yes Yes Yes Yes Recommend. This may be challenging

3 MINISTRY OF HEALTH RKA BUILDING, GRENADA WAY BARBADOS AVENUE GRENADA CRESCENT 10 A CHELSEA AVENUE KINGSTON 5, JAMAICA, W.I. Tel: (876) /7433/7771/8172 ANY REPLY OR SUBSEQUENT REFERENCE SHOULD BE ADDRESSED TO THE PERMANENT SECRETARY AND THE FOLLOWING REFERENCE QUOTED: REF NO: Website: Target/Criteria drivers under the influence of alcohol by at least 10% per year Establish a multisectoral national road safety action plan with timebound targets. Improve access to emergency care Reduce the time form serious injury to first emergency care provider by 10% per year High epidemiologic and public health relevance Evidence driven target and indicator Availability of effective and feasible public Health interventions Ease of communication (simplicity) Recommendation to measure objectively. Guidelines yet to be developed. Yes Yes Yes Yes Recommend Yes Yes Yes Yes Recommend. Also recommend Targets Reduction of injuries treated in Accident and Emergency by 10% - 80 % of Road Traffic Injuries discharged from Accident and Emergency ( a good indication of severity of injuries). Source of data: Hospital Reporting System Minister of Health - Dr. the Hon. Christopher Tufton, MP Permanent Secretary Mrs. Elaine Foster Allen

4 COMMENTS ON THE DEVELOPMENT OF GLOBAL TARGETS FOR ROAD SAFETY RISK FACTORS AND SERVICE DELIVERY MECHANISMS

5 MINISTRY OF TRANSPORT AND MINING PLANNING, RESEARCH AND EVALUATION ROAD SAFETY UNIT Report No. Date: WHO/RSU November 2016 Title Development of Global Targets for Road Safety Risk Factors and Service Delivery Mechanisms Prepared by: Kenute Hare Director, Road Safety Government of Jamaica 2016 Ministry of Transport and Mining World Health Organization Page 2 Planning, Research and Evaluation Road Safety Unit

6 TABLE OF CONTENTS Introduction..4 Vehicle Safety 4-5 Infrastructure Road User Behaviour 7-8 Institution Capacity..8 Emergency Care..9 Conclusion...9 Ministry of Transport and Mining World Health Organization Page 3 Planning, Research and Evaluation Road Safety Unit

7 1.0 Introduction The World Health Organization s Draft Document entitled developing voluntary global targets for road safety risk factors and service delivery mechanism s must be commended as it outlined a framework that Nation States can follow in order to reduce and even eliminate the rapacious nature of a traffic crash on the global road network. The need for voluntary targets is profoundly important as it will allow the States to incrementally address the prevailing issues. However, it is profoundly important that the capacity of the Nations are fully developed to deal with the issues to cauterize motor vehicles crashes. In respect of Jamaica, the Ministry of Transport and Mining is working assiduously to sustainably bring road fatalities Below 300. This is an arduous task and requires addressing the core areas outlined by the World Health Organization (WHO) road traffic injury prevention namely: Vehicle Safety; Road Infrastructure; Institutional Management of road safety; Road user behavior; and Emergency Jamaica would like to use this opportunity to comment on these Core areas and is proposing that the issue of crash victims is addressed as whilst we focus on the 1.25 million deaths, very little is done for the 50 million crash victims. The need for this issue is profoundly important as too many crash victims are not able to address their needs as the State s apparatus is overwhelmed by this scourge on the socio-economic fabric of the global society. 2.0 Vehicle Safety It cannot be that Ninety (90%) of the road traffic deaths are occurring in developing countries and a surgical approach is not taken to reduce or eliminate. Forty-eight (48%) of global motor vehicle fleet are operating on developing Countries road network. It should be noted that the issue of Motor Vehicle Standards or lack thereof is a profound issue in developing countries. In most developing Countries, there exists no Motor Vehicle Standards, thus substandard vehicles are traversing developing Countries road network. This is evident from the work of Global NCAP. There is a fundamental need for vehicles that traverse developing Countries road network to be of the same quality as those that traverse developed Ministry of Transport and Mining World Health Organization Page 4 Planning, Research and Evaluation Road Safety Unit

8 Countries, such as the United States. Safer Vehicles is a fundamental Pillar of the United Nations Decade of Action for Road Safety. The postulates evinced are important first steps but the World Health Organization (WHO) should begin the movement to impress upon Vehicle Manufacturers to equip motor vehicles manufactured with all the requisite safety gadgets, thus ensuring that the lives of persons who drive in developing Countries have access to the Safer Vehicles which are Standard in developed countries. Under the justification component, there should be a requirement that the following are added for vehicles manufactured: Alco-locks- this will make it impossible for persons to drive under the influence of alcohol. This technology is available but it is selectively executed in motor vehicles. This should be a standard device in all motor vehicles, just like how seatbelts are now installed in motor cars. Anti-lock Braking System- this also should be standard for all motor vehicles that operate on the global road network as it prevents tyres from being locked, thus allowing the driver to use up some of the energy to steer the vehicle. It is extremely important that all motor vehicles are equipped with the requisite safety features. The issue of under-ride crashes involving trucks are profoundly important, thus truck manufacturers should so design the truck in such a manner to eliminate the potential of under-ride crashes which can be calamitous. No car must be able to run under a truck. This happens too often in developing Countries. Manufacturers must not be allowed to manufacture trucks without ensuring under-ride protection. Finally, vehicle manufacturers should ensure that all vehicles manufactured are equipped with an Event Data Recorder which adheres to National Highway Traffic Safety Administration (NHTSA) Event Data Recorders (EDR)49CFR Part 563 Rule which requires that vehicles equipped with Event Data Recorders allow for the analysis of certain Data Elements. These Data Elements are crucial to the road safety efforts as it allows for better analysis, investigation of, and reconstruction of traffic crashes. Already, vehicles operating in the United States are equipped with this technology which provides the following Data Elements: Vehicle Speed; Brake Oil Pressure; Ministry of Transport and Mining World Health Organization Page 5 Planning, Research and Evaluation Road Safety Unit

9 Steering Input; and Shift Position In Jamaica, we have been able to access these Data Elements from Toyota Vehicles involved in traffic collisions. It is our position that all vehicles manufactured must be equipped with an Event Data Recorder that is readable. 3.0 Infrastructure The condition of the road surface is profoundly important if we are to sustainably reduce road traffic crashes, injuries and deaths. As it relates to infrastructure, the issue at hand is to get it right from the onset whereby the roads are designed for safety first, rather than cost. The issue at hand is that in many developing Countries, the roads are designed devoid of adhering to contemporary road safety design standards. Therefore, the World Health Organization (WHO) should insist that all new Road Projects are subjected to Road Safety Audits and existing roads are subjected to Road Safety Inspections. However, in order to achieve this feat, it is extremely important that the processes are firmly entrenched, but the capacity and capability of developing Countries must be enhanced to execute road safety audits and inspections. Jamaica has already invested heavily in developing these capabilities and is committed to executing both Road Safety Audits and Inspections.International Road Assessment Programmes are integral in the thrust to address road infrastructure safety issues, but this Programme must be coupled with a cadre of road safety professionals skilled in road infrastructure safety management. Failure to do so will be continuous catastrophe on the global road network. International Road Assessment Programmes(IRAP) star rating concept is costly, thus World Health Organization (WHO) should have funding specially in place whereby developing Countries can access to have their roadways analyzed in a comprehensive manner. The justifications outlined under this postulate is good but the crucial issue that is not addressed is where the funding will be coming from for developing Countries to critically addressed their infrastructure issues which are also outlined in the Safer Roads and Mobility Pillar. One of the key components of the Safer Roads and Mobility Pillar was that road authorities should commit a minimum of 10% of road budgets to dedicated safer road infrastructure programmes. There is a significant need for Ministry of Transport and Mining World Health Organization Page 6 Planning, Research and Evaluation Road Safety Unit

10 BehaviourModification Programmes in Developing Countries geared towards empowering the population, not only to do the correct thing but also to understand the consequences for their actions or inactions. World Health Organization s (WHO) is very good but there is need for both robust, rigid and continuous enforcement which is lacking in developing Countries. Therefore, the World Health Organization (WHO) must put the necessary mechanisms in place that will cause developing Countries to have Robust Road Safety Enforcement capabilities as Road Safety Education without Enforcement will not work, especially indeveloping Countries where the dependence is on human enforcement rather than the integration of technology with human. The World Health Organization (WHO) Document highlighted the following risk factors: Speeding; Helmet use; Seatbelt use; and Alcohol I would recommend that the following risk factors are added and scoped accordingly: Distractions; Fatigue driving; and Vehicle safety The World Health Organization (WHO) must push for this to happen globally but it must also push for this Special Fund for Developing Countries. 4.0 Road User Behaviour Over Ninety (90%)of the crashes in Jamaica are due to human behavior which in most instances creates needless calamities. The issues highlighted by the World Health Organization (WHO) are congruent with what s happening in Jamaica and most developing Countries. The risk factors outlined are contemporary and if they are addressed, road deaths will reduce. However, due to ad hoc enforcement, these risk factors continue in respect of motorcyclists fatalities. Ministry of Transport and Mining World Health Organization Page 7 Planning, Research and Evaluation Road Safety Unit

11 Also to address the issue of driving under the influence of alcohol, it is imperative that the World Health Organization (WHO) begins the process of campaigning for Alcolocks to be placed in vehicles similar to how seatbelts are placed in motor vehicles. Distraction is the modern plague that if not controlled will create catastrophe in the traffic environment. Firstly, some of these distractions are In-Vehicle Technologywhich when misused have the potential to cause serious crashes. The promotion of hands-free devices whilst driving is dangerous as it is recipe for disaster. One of the challenges that developing Countries face is the prevalence of motorcycles on the road network. Many of these motorcyclists are not wearing helmets, thus they are refusing to give themselves a fighting chance to survive the crash. Approximately Eighty-three (83) motorcyclists have been killed since the start of the year in Jamaica. Only one was wearing a helmet at the time of the crash. Therefore, it would be great if the World Health Organization (WHO) could have helmets donated to developing Countries where there exist high incidences ofthese crashes. 5.0 Institutional Capacity Every country should have a Lead Agency to assist in the coordination of Road Safety activities. This Lead Agency should be independent. It should be properly equipped with the requisite human and financial resources. This Lead Agency plays a crucial role in the road safety affairs of the State and should support the various governmental and nongovernmental entities involved in the road safety battle. The World Health Organization (WHO) should begin the process of encouraging the concept of a Lead Agency and also set up capacity reviews for Lead Agencies which exists. The World Health Organization (WHO) should propose a model which will ensure that the road safety efforts are not affected. 6.0 Emergency Care Whilst improving access to emergency care is very important, actually what took place at the Crash Scene is also very critical. It is my view that the following issues should be incorporated under emergency care: Cadre of trained Emergency Management Technicians; Cadre of trained First Responders; Ministry of Transport and Mining World Health Organization Page 8 Planning, Research and Evaluation Road Safety Unit

12 Equipment needed to remove crash victims from vehicles; and Justice for Crash Victims and bereaved families Finally, the World Health Organization (WHO) should include improving the post-crash response under emergency care. The stakeholders involved in emergency care should be properly equipped and Nation States should be assisted to improve this area. 7.0 Conclusion This proposed document is a step in the right direction in addressing the road safety issues. However, there still exists a lot that States must do in order to curtail motor vehicle crashes. The five pillars of the United Nations Decade of Action for Road Safety are very important, thus systematic assistance must be given to developing Countries to close the gaps which exists under each Pillar. Road traffic crashes, injuries and deaths have affected the GDP of many Nations, thus all States must crucially look at this Document and implement the systems and mechanisms to improve their road safety operations. I would like to propose that States could contact the International Traffic Accident Database (IRTAD) and forge a Twinning Alliance to improve their road safety architecture. Ministry of Transport and Mining World Health Organization Page 9 Planning, Research and Evaluation Road Safety Unit

13 Comments of the Government of Jamaica on the World Health Organisation (WHO)Development of Global Targets for Road Safety Risk Factors and Service Delivery Mechanisms The Government of Jamaica welcomes the opportunity to provide inputs for the establishment of voluntary global targets for road safety risk factors and service delivery mechanisms. The development of targets will assist States in addressing the persistent challenges plaguing road safety worldwide. It is noted that significant investment will be required to meet targets and a clear articulation of timeline in respect of these targets is crucial to effective implementation. The Government of Jamaica is working to sustainably reduce road fatalities below 300. This is a mammoth feat and will require focussing on the core areas outlined by the WHO road traffic injury prevention namely: Vehicle Safety Road Infrastructure Institutional management of road safety Road user behaviour; and Emergency In addition to the 1.25 million fatalities, it is proposed that the needs of the 50 million crash victims be adequately addressed in recognition of the effect on productivity and path to sustainable development for developing countries. Vehicle Safety It is noted that ninety (90%) of the road traffic deaths occur in developing countries and forty-eight (48%) of the global motor vehicle fleet operate on developing countries road network. The issue of Motor Vehicle Standards or lack thereof is a concern for Jamaica as motor vehicle standards do not exist in most developing countries. There is a fundamental need for vehicles that traverse developing countries road network to be of the same quality as those that traverse developed countries. Safer Vehicles is a fundamental Pillar of the United Nations Decade of Action for Road Safety. Vehicle manufacturers should be obligated to equip motor vehicles with the requisite safety gadgets, thus ensuring that the motorists in developing countries have access to the Safer Vehicles which are standard in developed countries. Under the justification component, there should be a requirement that the following are added for vehicles manufactured: Alco-locks- this will make it impossible for persons to drive under the influence of alcohol. This should be a standard device in all motor vehicles, comparable to the standard requirement for seatbelts.

14 Anti-lock Braking System- this also should be standard for all motor vehicles that operate on the global road network as it prevents tyres from being locked, thus allowing the driver to use up some of the energy to steer the vehicle. The issue of under-ride crashes involving trucks is a cause of major concern. Truck manufacturers should design trucks to eliminate the potential of under-ride crashes which can be calamitous. Finally, vehicle manufacturers should ensure that all vehicles are equipped with an Event Data Recorder which adheres to National Highway Traffic Safety Administration (NHTSA) Event Data Recorders (EDR)49CFR Part 563 Rule which require vehicles equipped with Event Data Recorders to allow for the analysis of certain data elements. These data elements are crucial to the road safety efforts as it allows for better analysis, investigation, and reconstruction of traffic crashes. Already, vehicles operating in some countries are equipped with this technology which provides the following data elements: Vehicle Speed; Brake Oil Pressure; Steering Input; and Shift Position In Jamaica, we have been able to access these data elements from Toyota Vehicles involved in traffic collisions. It is our position that all vehicles manufactured should be equipped with a readable event data recorder. Road Infrastructure As it relates to infrastructure, roads should be designed for safety as the first priority. In most cases, cost is the primary consideration. In many developing countries, the roads are designed devoid of adhering to contemporary road safety design standards. Therefore, there should be a push to subject all new road projects to road safety audits and existing roads to road safety inspections. However, in order to achieve this feat, it is extremely important that the processes are firmly entrenched, and the capacity and capability of developing countries enhanced to execute road safety audits and inspections. Jamaica has invested heavily in developing these capabilities and is committed to executing both road safety audits and inspections. International Road Assessment Programmes (IRAP) are integral in the thrust to address road infrastructure safety issues, but these programmes must be coupled with a cadre of road safety professionals skilled in road infrastructure safety management. It is noted that several initiatives geared at road safety are expensive, for e.g., the IRAP star rating.in this regard, the critical matter of dedicated and sustainable funding for developing countries should be addressed. Access to funding will assist these countries in addressing infrastructure issues outlined in the Safer Roads and Mobility pillar including comprehensive analysis of roadways. One of the key components of the Safer Roads and Mobility Pillar was that road authorities should commit a minimum of 10% of road budgets to dedicated safer road infrastructure programmes. Road User Behavior

15 There is a significant need for Behaviour Modification Programmes in developing countries geared towards building public awareness and engendering a safe culture among road users. The matter of road safety enforcement is a key partner to road safety education and other behavior-related efforts. The World Health Organization (WHO) is encouraged to set the necessary mechanisms in place to support developing countries in building robust road safety enforcement capabilities, especially in developing countries where the dependence is on human enforcement rather than the integration of technology with human. In addition to the risk factors highlighted by the WHO, the Government of Jamaica recommends the following factors: Distractions; Fatigue driving; and Vehicle safety Over ninety (90%) of the crashes in Jamaica are due to human behavior. The issues highlighted by the World Health Organization (WHO) are congruent with the reality in Jamaica and most developing countries. The risk factors outlined are contemporary and, if addressed, should result in fewer road deaths. However, due to ad hoc enforcement, these risk factors continue in respect of motorcyclists fatalities. Distraction is the modern plague that if not controlled will create catastrophe in the traffic environment. The misuse of In-Vehicle Technology, such as use of hands-free devices while driving, has tremendous potential to cause serious crashes. One of the challenges faced by developing countries is the prevalence of motorcycles on the road network, many of whom do not wear helmets. Approximately eighty-three (83) motorcyclists have been killed since the start of the year in Jamaica. Only one was wearing a helmet at the time of the crash. A donation of helmets to developing countries where there exist high incidences of these crashes could assist in reducing fatalities. Institutional Capacity It is recommended that every country designate an agency to assist in the coordination of road safety activities. The designated body should be independent and properly resourced as it will play the primary role in the road safety affairs of the State and support the various governmental and nongovernmental entities involved in attaining the highest reach of road safety. The World Health Organization (WHO) is encouraged to promote the concept of such a body, including proposal of a model Agency, and establish capacity reviews for existing bodies. Emergency Care It is proposed that the following issues be incorporated under emergency care:

16 Cadre of trained Emergency Management Technicians; Cadre of trained First Responders; Equipment needed to remove crash victims from vehicles; and Justice for Crash Victims and bereaved families The improving the post-crash response should also be included under emergency care, with stakeholders adequately equipped for the task. Conclusion This proposed document is a step in the right direction in addressing the road safety issues. However, it is acknowledged that much work remains to achieve the global vision. The five pillars of the United Nations Decade of Action for Road Safety are very important and systematic assistance must be given to developing countries to close the gaps which exist under each Pillar. Road traffic crashes, injuries and deaths are a sustainable development issue and should be addressed in a comprehensive and holistic manner to ensure that no country is left behind. Member States are encouraged to adopt innovative approaches and partnerships to improve road safety architecture, including utilizing the International Traffic Accident Database (IRTAD). Table 1: Review of proposed global voluntary global targets for road safety risk factors and service delivery mechanisms Target/Criteria High epidemiologic and public health relevance Evidence driven target and indicator Availability of effective and feasible public Health interventions Ease of communication (simplicity) Recommendation Eliminate production of substandard new vehicles 100% of new vehicles (defined as produced or sold) meeting 4 Important and relevant. Important and relevant. Yes Yes As Jamaica is not a manufacturer of motor vehicles, this target is important to ensure that vehicles imported are safe vehicles for citizens. Yes - Yes Recommended. Should include target for old vehicles as most developing

17 Target/Criteria High epidemiologic and public health relevance Evidence driven target and indicator Availability of effective and feasible public Health interventions Ease of communication (simplicity) Recommendation priority UN regulations nations would have old vehicles. There is a large used car market. Eliminate high risk roads Yes Yes Yes Yes Recommended 100% of new roads are 3 star or better for all road users. > 75% of travel on existing roads are 3 star or better for all road users. Yes Yes Yes Yes Ambitious target which may not be attainable. A target of > 50% is recommended. Reduce speed the proportion of vehicles travelling at beyond the posted speed limit by at least 10% per year Yes Yes Yes, but will be challenging to implement and will require significant investment in infrastructure and health promotion. Yes Recommend. A concern as to how this will be measured via country survey. It would be useful to learn how this target/indicator will be measured by other Member States Reduce the proportion of unhelmeted motorcycle riders by at least 10% per year or at least 90% helmet wearing. Reduce the proportion of drivers under Yes Yes Yes Yes Recommend Yes Yes Yes Yes Recommend. This may be challenging to measure

18 Target/Criteria High epidemiologic and public health relevance Evidence driven target and indicator Availability of effective and feasible public Health interventions Ease of communication (simplicity) Recommendation the influence of alcohol by at least 10% per year objectively. Guidelines yet to be developed. Establish a multisectoral national road safety action plan with timebound targets. Improve access to emergency care Reduce the time form serious injury to first emergency care provider by 10% per year Yes Yes Yes Yes Recommend Yes Yes Yes Yes Recommend. Also recommend Targets Reduction of injuries treated in Accident and Emergency by 10% - 80 % of Road Traffic Injuries discharged from Accident and Emergency ( a good indication of severity of injuries). Source of data: Hospital Reporting System