tag:theconversation.com,2011:/fr/topics/road-accident-11280/articlesroad accident – The Conversation2023-06-27T20:37:33Ztag:theconversation.com,2011:article/2083572023-06-27T20:37:33Z2023-06-27T20:37:33ZAfter the Manitoba crash, Canada needs to rethink bus safety<figure><img src="https://images.theconversation.com/files/534154/original/file-20230626-7296-j4ekvm.JPG?ixlib=rb-1.1.0&rect=7%2C14%2C4985%2C3525&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The intersection along the Trans-Canada highway near Carberry, Man. where a bus collided with a semi-truck killing 16 people and injuring nine others. </span> <span class="attribution"><span class="source">THE CANADIAN PRESS/Darryl Dyck</span></span></figcaption></figure><p>The <a href="https://theconversation.com/manitoba-crash-highlights-safety-concerns-about-canadas-highways-and-trucking-industry-207971">recent collision</a> between a bus and a semi-truck near Carberry, Man., which killed <a href="https://www.cbc.ca/news/canada/manitoba/manitoba-bus-crash-victims-profiles-1.6885087">16 seniors</a>, is the latest fatal incident to raise concerns about bus and road safety in Canada. The crash shares similarities to other fatal bus crashes like the <a href="https://www.thecanadianencyclopedia.ca/en/article/humboldt-broncos-bus-crash">2018 Humboldt Broncos bus crash</a> and the <a href="https://globalnews.ca/news/5902629/serious-rollover-bus-crash-on-vancouver-island/">2019 bus rollover on Vancouver Island</a>.</p>
<p>Buses are one of the safest modes of transportation. However, these tragic incidents show that major crashes can result in significant loss of life, severe injuries and profound grief for entire communities.</p>
<p>Safety investigations into such collisions need to be conducted at a national level and by an independent body in the same manner air and rail occurrences are investigated.</p>
<h2>Road transportation is a provincial responsibility</h2>
<p>When it comes to road transportation, Canada adheres to an archaic <a href="https://lop.parl.ca/sites/PublicWebsite/default/en_CA/ResearchPublications/202204E#a3">regulatory framework</a> that can be traced all the way back to confederation. At the time, John A. Macdonald <a href="https://macdonaldlaurier.ca/files/pdf/MLIConfederationSeries_MacdonaldSpeechF_Web.pdf">argued</a> that roads should be a provincial responsibility with no federal involvement or guidance.</p>
<p>At the time, most roads were not paved and road vehicles were horse-drawn. Roads carried less national strategic significance than railroads and waterways which both became federally-regulated.</p>
<p>After confederation, Canada became the second largest country in the world by area, and roads became the lifeline of our transportation infrastructure system. However, roads still remain under provincial jurisdiction and that makes far less sense now.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/534145/original/file-20230626-29-gxsgrx.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="People sit in a room with large portraits. An RCMP officer stands at a podium addressing them." src="https://images.theconversation.com/files/534145/original/file-20230626-29-gxsgrx.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/534145/original/file-20230626-29-gxsgrx.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/534145/original/file-20230626-29-gxsgrx.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/534145/original/file-20230626-29-gxsgrx.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/534145/original/file-20230626-29-gxsgrx.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/534145/original/file-20230626-29-gxsgrx.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/534145/original/file-20230626-29-gxsgrx.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Family members of 16 seniors who died in the accident attend an RCMP press conference in Dauphin, Man. on June 22, 2023.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/The Brandon Sun - Tim Smith</span></span>
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</figure>
<h2>Improving road safety</h2>
<p>Canada’s lack of effective leadership of <a href="https://tc.canada.ca/en/corporate-services/transparency/corporate-management-reporting/transportation-canada-annual-reports/road-transportation">road transportation</a> is inconsistent with practices in many other developed nations. Improving road safety and standards should include developing national standards, guidance and dedicated funding sources (for example, gas tax) to support the construction and operation of road networks.</p>
<p>In 2018, Canada <a href="https://tc.canada.ca/en/road-transportation/publications/road-safety-canada-2020#Overall-Level-of-Road-Safety-in-Canada">ranked 12th</a> compared to other member countries in the Organization for Economic Co-operation and Development in terms of road safety. </p>
<p>In 2016, the Canadian Council of Motor Transport Administrators published its <a href="https://roadsafetystrategy.ca/en/strategy">Road Safety Strategy</a>. The strategy aims to raise public awareness of road safety as well as improve legislation and infrastructure. However, progress has been slow and often hampered by a lack of systemic efforts to collect, analyze and share publicly relevant data and research.</p>
<p>To fill the gaps, non-mandatory guidance is being developed collaboratively by not-for-profit associations and inter-governmental forums such as the <a href="https://www.tac-atc.ca/en/about-tac">Transportation Association of Canada</a>, <a href="https://www.ccmta.ca/en/about">the Canadian Council of Motor Transport Administrators</a> and <a href="https://www.comt.ca/#:%7E:text=The%20Council%20of%20Ministers%20Responsible">the Council of Ministers of Transport</a>.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/534161/original/file-20230626-15-x6xeh5.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A damaged semi-truck on a road." src="https://images.theconversation.com/files/534161/original/file-20230626-15-x6xeh5.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/534161/original/file-20230626-15-x6xeh5.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=307&fit=crop&dpr=1 600w, https://images.theconversation.com/files/534161/original/file-20230626-15-x6xeh5.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=307&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/534161/original/file-20230626-15-x6xeh5.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=307&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/534161/original/file-20230626-15-x6xeh5.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=385&fit=crop&dpr=1 754w, https://images.theconversation.com/files/534161/original/file-20230626-15-x6xeh5.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=385&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/534161/original/file-20230626-15-x6xeh5.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=385&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The aftermath of the collision near Carberry, Man. The incident is the latest to raise concerns about passenger and road safety in Canada.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Steve Lambert</span></span>
</figcaption>
</figure>
<h2>Response to major road crashes</h2>
<p>In Canada, federal regulations govern transportation by rail, air and water. The safety of the users of these systems are under the purview of a federal watchdog, the <a href="https://www.tsb.gc.ca/eng/qui-about/index.html">Transportation Safety Board (TSB)</a>, which is overseen and funded by Parliament. This allows the TSB to investigate all matters related to these modes and to press all levels of government for change.</p>
<p>Roads are the exception. The TSB has no role in investigating road crashes or bridge failures no matter how catastrophic. That is usually left to provincial and municipal authorities. This stands in contrast to other countries like the United States, which <a href="https://www.ntsb.gov/about/Pages/default.aspx">empower a national agency to investigate highway safety</a>.</p>
<p>The TSB was absent from the <a href="https://leaderpost.com/news/saskatchewan/humboldt-broncos-bus-crash-13-recommendations-to-improve-safety-at-intersection">Humboldt Broncos crash</a>, the <a href="https://www.westernwheel.ca/beyond-local/investigation-complete-into-fatal-icefield-bus-rollover-5294681">Columbia Icefield crash</a>, the <a href="https://vancouverisland.ctvnews.ca/uvic-says-it-has-implemented-recommendations-after-fatal-bus-crash-near-bamfield-1.5500159">University of Victoria bus crash</a>, and is absent from the Carberry crash, all because its mandate does not cover roads. </p>
<p>Meanwhile, the TSB joined the investigation into the implosion of the <a href="https://www.bst-tsb.gc.ca/eng/medias-media/deploiement-deployment/marine/2023/m23a0169-20230623.html">Titan submersible</a> in international waters because the support ship flew a Canadian flag.</p>
<p>The TSB investigated a <a href="https://www.cbc.ca/news/canada/ottawa/ottawa-bus-train-crash-kills-6-in-commuting-horror-1.1858868">2013 double-decker bus crash</a> in Ottawa because the bus collided with a train and rail is a federally-regulated mode, but was unable to investigate another <a href="https://ottawacitizen.com/opinion/columnists/the-humboldt-parents-ottawa-please-ask-the-transportation-safety-board-to-probe-the-bus-crash">double-decker crash also in Ottawa</a> in 2019 because the bus collided with a station shelter awning on the City-owned transitway. </p>
<p>In both cases, the bus structure proved to be weak and easily breached, which led to ejection of passengers from the upper decks. A <a href="https://www.tsb.gc.ca/eng/rapports-reports/rail/2013/r13t0192/r13t0192.html">public report</a> was issued after the first crash. No report or recommendations were issued after the second, and an opportunity to advance safety was missed.</p>
<p>Best practices dictate that serious road crashes across the country be investigated by an independent body. That would allow us to see the bigger and clearer picture, and to detect trends more accurately. We need this knowledge to justify necessary safety actions such as traffic countermeasures, infrastructure upgrades, stronger bus structures, seatbelts, event data loggers and mandatory bus driver training.</p>
<p>For these reasons, we must demand that serious road crashes be subject to the same type of independent and transparent safety investigations that are routinely conducted in other modes.</p>
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<a href="https://images.theconversation.com/files/534160/original/file-20230626-17-4ej31x.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A stop sign at an intersection. A memorial is seen in the background." src="https://images.theconversation.com/files/534160/original/file-20230626-17-4ej31x.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/534160/original/file-20230626-17-4ej31x.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/534160/original/file-20230626-17-4ej31x.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/534160/original/file-20230626-17-4ej31x.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/534160/original/file-20230626-17-4ej31x.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/534160/original/file-20230626-17-4ej31x.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/534160/original/file-20230626-17-4ej31x.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A memorial on the roadside where the Humboldt Broncos bus crash took place is shown on Highway 35 near Armley, Sask. on March 18, 2023.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Liam Richards</span></span>
</figcaption>
</figure>
<h2>Stalled progress</h2>
<p>In 2019, on the heels of the Humboldt Broncos bus crash, the House of Commons Committee on Transportation, Infrastructure and Communities studied bus passenger safety. The committee interviewed first-responders, bus industry representatives, the TSB and safety experts.</p>
<p>The committee’s report contained <a href="https://www.ourcommons.ca/DocumentViewer/en/42-1/TRAN/report-31/page-24">nine important recommendations</a> to improve bus passenger safety. It recommended the Government of Canada enable the TSB to investigate serious highway accidents, as well as all accidents involving motor vehicles designed to transport nine or more passengers. The report also recommended that bus drivers be required to undertake mandatory entry-level training.</p>
<p>The report went nowhere.</p>
<p>Transport Canada did not respond to the report as would normally be expected. The committee was told that Transport Canada was in the process of <a href="https://www.ourcommons.ca/DocumentViewer/en/42-1/TRAN/report-31/page-18">developing regulatory changes</a> to improve bus passenger safety in collaboration with provincial and territorial governments and needed more time to finalize the work. </p>
<p>Four years later, there has been little progress on the recommendations. The cost of waiting is too high. Politicians continue to offer only thoughts and prayers after each tragic incident, but it is time for them to revisit their own bus passenger safety report. </p>
<p>The House of Commons needs to follow up on the recommendations and demand that regulatory changes be introduced to make bus travel safer.</p><img src="https://counter.theconversation.com/content/208357/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ahmed Shalaby receives funding from the Natural Sciences and Engineering Research Council of Canada, Manitoba Department of Transportation and Infrastructure, and the City of Winnipeg. He is a professional engineer and a member of the Pavements and the Soil and Materials Standing Committees of the Transportation Association of Canada. He is a director of Safer Roads Canada, a not-for-profit group created by families of crash victims.
</span></em></p>Safety investigations into serious road collisions need to be conducted at a national level and by an independent body in the same manner air and rail occurrences are investigated.Ahmed Shalaby, Professor of Civil Engineering, University of ManitobaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2079712023-06-21T21:25:31Z2023-06-21T21:25:31ZManitoba crash highlights safety concerns about Canada’s highways and trucking industry<p>Details are still emerging about the recent <a href="https://www.cbc.ca/news/canada/manitoba/bus-crash-seniors-manitoba-carberry-1.6879773">collision between a bus carrying seniors and a semi-truck</a> in Manitoba. It is now clear that the <a href="https://www.rcmp-grc.gc.ca/en/news/2023/manitoba-rcmp-respond-mass-casualty-collision">truck had right of way</a>, however, police have not yet determined cause or potential culpability. </p>
<p>What we know for certain is that this is one of the worst road accidents in recent Canadian history. <a href="https://www.cbc.ca/news/canada/manitoba/survivor-carberry-crash-dies-hospital-death-16-1.6883717">Sixteen people are dead</a> and nine others remain in hospital. The scale of the incident is shocking, and it will take time for investigators to determine all the factors at play. </p>
<p>The incident has raised questions about the safety of at-grade intersections, where local roads intersect with highways. Manitoba Premier Heather Stefanson has said the province will <a href="https://www.burnabynow.com/national-news/manitoba-to-review-deadly-intersection-bring-in-experts-if-needed-premier-7162983">review the safety</a> of the intersection where the collision occurred. Such reviews are necessary and need to take place across the country. </p>
<p>Too often, there is a problematic blame game after these collisions. It is all too easy to rush to judgement and blame truck drivers. However, the involvement of a semi-truck was clearly a factor in the sheer scale and deadliness of the crash. That fact, as well as <a href="https://thestarphoenix.com/news/deadly-carberry-manitoba-bus-crash-echoes-humboldt-broncos-tragedy">comparisons to the 2018 Humboldt Broncos bus crash in Saskatchewan</a>, means questions will likely be raised about trucking industry safety.</p>
<h2>Trucker safety</h2>
<p>The mass casualties associated with the <a href="https://globalnews.ca/news/9773737/carberry-bus-crash-humboldt-broncos/">Humboldt collision</a> and the <a href="https://newsinteractives.cbc.ca/longform/humboldt-crash-jaskirat-singh-sidhu/">criminal conviction</a> of the truck driver involved increased public attention to trucking industry safety. </p>
<p>There is general recognition that truck drivers have a heightened responsibility to drive safely because of the increased risk posed by the size and weight of their vehicles. <a href="https://northernontario.ctvnews.ca/opp-say-preventable-transport-truck-crashes-on-the-rise-1.5980613">Police</a>, <a href="https://www.cbc.ca/news/canada/british-columbia/rob-fleming-highway-5-truck-crashes-1.6751632">politicians</a> and <a href="https://edmonton.citynews.ca/2023/04/06/humboldt-highway-safety/">members of the public</a> have raised concerns that unsafe driving among truckers is getting worse, and <a href="https://doi.org/10.29173/cjs28288">my research</a> indicates that many truckers share these concerns.</p>
<p>Responses to this issue have mainly focused on changing truck driver behaviour. This includes adopting basic <a href="https://www.trucknews.com/features/melt-truck-driver-training-standards-are-only-minimums-and-gaps-remain/">mandatory truck driver training</a> and <a href="https://news.gov.bc.ca/releases/2023MOTI0013-000178">compliance initiatives</a>. However, focusing solely on the behaviour of truck drivers obscures the complex ways the organization and regulation of the industry are at odds with public safety. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/533005/original/file-20230620-19688-b5ym4j.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="A scorched patch of ground near a highway intersection. Skid marks leading to the scorched patch are seen on the roadway." src="https://images.theconversation.com/files/533005/original/file-20230620-19688-b5ym4j.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/533005/original/file-20230620-19688-b5ym4j.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=424&fit=crop&dpr=1 600w, https://images.theconversation.com/files/533005/original/file-20230620-19688-b5ym4j.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=424&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/533005/original/file-20230620-19688-b5ym4j.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=424&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/533005/original/file-20230620-19688-b5ym4j.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=533&fit=crop&dpr=1 754w, https://images.theconversation.com/files/533005/original/file-20230620-19688-b5ym4j.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=533&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/533005/original/file-20230620-19688-b5ym4j.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=533&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">A scorched patch of ground where the bus carrying seniors ended up after colliding with the semi is seen on the edge of the Trans-Canada Highway where it intersects with Hwy 5 near Carberry, Man., June 16, 2023.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Darryl Dyck</span></span>
</figcaption>
</figure>
<p>The majority of long haul truck drivers in Canada work as contractors who are <a href="https://www.truckerstrainingcanada.com/truck-drivers-salary-canada/#How_Do_Truck_Drivers_Earn">paid by the kilometre</a>. That means most truckers only make money when they are moving. The further and faster they go, the more they make. </p>
<p>Most truckers are not paid for loading and unloading, securing cargo, mechanical inspections and so on. Conducting safety checks, brake adjustments or even slowing down all cost drivers time and money. To anyone interested in public safety, this is ludicrous.</p>
<p>Then there are regulations regarding truckers’ hours of service. Under these rules, once a trucker starts driving, the clock on their allowable driving window begins. According to the <a href="https://www.cvse.ca/hours_of_service.htm">National Safety Code</a>, truckers can drive a maximum of 13 hours in a work day. In my research, I have interviewed truck drivers who spoke about the pressure those hours can have. <a href="https://doi.org/10.29173/cjs28288">As one driver explained</a>: </p>
<blockquote>
<p>I used to drive, and if I felt tired, I pull over and have a nap! And then I could just get up again, and drive. You can’t do that now. […] They think that they are changing the rules to make it safer! You’re not! </p>
</blockquote>
<p>All these pressures combine to push drivers to keep going — no matter what. Current regulations and by-the-kilometer pay discourage and penalize drivers from resting when they feel tired, or stopping when road conditions are bad.</p>
<h2>Truckers under pressure</h2>
<p>Working conditions for long haul truckers are also challenging and create safety issues. When drivers do finally stop, they often attempt to rest in a noisy truck stop parking lot or remote highway pullout. They may or may not have regular access to food, bathrooms or showers. They are away from their families, health-care providers and communities for long stretches of time. Access to healthy food is limited, and <a href="https://doi.org/10.2190/ns.24.1.c">there are very real health implications to doing this kind of work</a>.</p>
<p>Small wonder, then, that there is a <a href="https://www.newswire.ca/news-releases/government-of-canada-invests-in-skills-training-to-address-shortages-in-trucking-industry-824459499.html">shortage of truckers</a>. To find drivers, companies increasingly rely on initiatives such as the <a href="https://www.canada.ca/en/employment-social-development/programs/temporary-foreign-worker.html">Temporary Foreign Worker Program</a>. These workers are especially vulnerable to exploitation and unsafe work. The increasing reliance on these programs is also <a href="https://doi.org/10.3167/TRANS.2016.060105">factoring into racism in the industry</a>. </p>
<p>When we think about semi truck-involved collisions, we rarely think about the impacts of road collisions on truck drivers themselves. This is not to diminish the unimaginable loss, pain and suffering of the victims of any truck-involved collision. But if we only think of truck drivers as potential perpetrators of collisions, then we can’t recognize the harm many truckers experience or the links to public safety. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/533014/original/file-20230620-27-9b5n3f.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="smoke rises from the scene of a road accident. a damaged blue semi-truck is seen in the background." src="https://images.theconversation.com/files/533014/original/file-20230620-27-9b5n3f.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/533014/original/file-20230620-27-9b5n3f.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=466&fit=crop&dpr=1 600w, https://images.theconversation.com/files/533014/original/file-20230620-27-9b5n3f.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=466&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/533014/original/file-20230620-27-9b5n3f.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=466&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/533014/original/file-20230620-27-9b5n3f.JPG?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=586&fit=crop&dpr=1 754w, https://images.theconversation.com/files/533014/original/file-20230620-27-9b5n3f.JPG?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=586&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/533014/original/file-20230620-27-9b5n3f.JPG?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=586&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Manitoba Premier Heather Stefanson has said the province will review the safety of the intersection where the collision occurred.</span>
<span class="attribution"><span class="source">THE CANADIAN PRESS/Handout: Nirmesh Vadera</span></span>
</figcaption>
</figure>
<p>Due to the sheer number of hours and long distances they travel, truck drivers are at higher risk of being in, and witnessing, a road collision. Many of the truckers I’ve spoken to as part of <a href="https://summit.sfu.ca/item/17764">my research</a> recounted harrowing stories of witnessing road collisions. </p>
<p>Many had experiences of saving crash victims’ lives, providing end-of-life care and dealing with human remains at collision sites. Often this work was voluntary. Other times, police and first responders requested their help. </p>
<p>What happens after such incidents? Often, truckers keep driving. It may be hours before they can shower or take a break. They often have <a href="https://www.ihsa.ca/Topics-Hazards/Mental-health-risks-and-stigma-in-the-trucking-ind.aspx">little or no access to mental health supports</a>. Their ability to rest and recover depends on their employer, the individual job and their relationships with dispatchers. </p>
<p>Nothing about this is safe for anyone. </p>
<p>It is easy to dehumanize truckers and assume they are at fault in any collision. Among the professional truck drivers I have known, there is no greater fear than being at fault in a fatal collision.</p>
<p>Canada’s long-haul truckers are facing dangerous working conditions. Governments need to take meaningful action to improve the safety of Canada’s highways and regulation of the trucking industry.</p><img src="https://counter.theconversation.com/content/207971/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amie McLean received research funding from the Social Sciences and Humanities Research Council of Canada. </span></em></p>Long-haul truckers often work grueling schedules with few breaks and face pressures that place their safety and that of others at risk.Amie McLean, Intercultural Coordinator, Thompson Rivers University; Project Manager, Justice, Equity, and Inclusion, Work-Integrated Learning (on leave), Simon Fraser UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/2057002023-05-29T13:10:10Z2023-05-29T13:10:10ZDrink up, it’s closing time: South African study calculates that limiting opening hours will save lives<figure><img src="https://images.theconversation.com/files/527034/original/file-20230518-17-8xdcj5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><span class="source">Cristi Lucaci/Shutterstock</span></span></figcaption></figure><p>South Africans are among the heaviest drinkers in the world. The country has the highest per capita rate of <a href="https://www.who.int/publications/i/item/9789241565639">alcohol consumption</a> in Africa. Excessive drinking is especially widespread in the Western Cape. Research <a href="https://dgmt.co.za/wp-content/uploads/2023/02/Minumum-Unit-Pricing-Phase-1.1-Modelling-Impact-of-MUP-15112021-FINAL-1.pdf">estimates</a> that per capita alcohol consumption in the province is between 30% and 40% higher than the national consumption. </p>
<p>Alcohol use contributes to <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-019-7771-4">over 200</a> different diseases, injuries and conditions. It is also a risk factor for gender-based violence and <a href="https://www.westerncape.gov.za/assets/departments/health/mortality_profile_2016.pdf">violent crime</a>. </p>
<p>In a bid to reduce alcohol-related harms in the province, the Western Cape government has <a href="https://www.westerncape.gov.za/text/2017/September/white_paper_alcohol-related_harms_reduction.pdf">proposed</a> a policy to restrict trading hours for onsite alcohol consumption. International <a href="https://pubmed.ncbi.nlm.nih.gov/28647704/">research</a> shows that reducing trading hours is an effective way to curb alcohol consumption and its associated harms. This type of policy is also supported by the <a href="https://apps.who.int/iris/bitstream/handle/10665/259232/WHO-NMH-NVI-17.9-eng.pdf">World Health Organization</a>. </p>
<p>My colleagues and I at the University of Cape Town recently conducted a modelling <a href="https://dgmt.co.za/wp-content/uploads/2023/03/Trading-Hours-Phase-2-Modelling-Trading-Times-Final-Report-vf.pdf">study</a>. We wanted to determine the health and economic impacts of restricting the hours of onsite alcohol consumption. </p>
<p>We considered three latest closing-time scenarios: midnight, 1am and 2am. Data for the model baseline was drawn from national surveys on alcohol consumption, the national treasury’s annual budget reviews and publications from Statistics South Africa and the South African Medical Research Council. </p>
<p>We estimated the impact of each of the proposed closing times on the number of cases and deaths associated with certain health conditions. The study also assessed the policy’s impact on alcohol expenditure, excise tax, value added tax and retail revenue. Finally we estimated the impact on the cost of combating alcohol-related crime in the Western Cape.</p>
<p>Our <a href="https://dgmt.co.za/wp-content/uploads/2023/03/Trading-Hours-Phase-2-Modelling-Trading-Times-Final-Report-vf.pdf">results</a> make it clear that limiting the hours for onsite consumption of alcohol will save lives. It will also prevent alcohol-related diseases and injuries, and reduce hospital and crime prevention costs.</p>
<p>On the other hand, national tax revenue and revenue to the alcohol industry will decrease. </p>
<h2>The findings</h2>
<p>We looked at how the policy might affect public health costs of six alcohol-related conditions. We also factored in the hospital costs of treating these conditions. The conditions we looked at were: road injury; intentional injury; liver cirrhosis; HIV; TB; and breast cancer. </p>
<p>Model estimates suggest that all closing-time scenarios correspond to decreases in six areas. These are: </p>
<ul>
<li><p>alcohol consumption</p></li>
<li><p>number of deaths due to the six alcohol-related conditions</p></li>
<li><p>number of cases of these six conditions</p></li>
<li><p>hospital costs of these conditions</p></li>
<li><p>cost of combating alcohol-related crime</p></li>
<li><p>revenue from alcohol sales and alcohol taxation.</p></li>
</ul>
<p>We estimated how much lower the number of cases of the six conditions would be over the next 20 years. The cases averted were:</p>
<ul>
<li><p>163,800 to 453,000 under the midnight closing-time scenario </p></li>
<li><p>88,700 to 220,300 (1am scenario) </p></li>
<li><p>12,600 to 28,300 (2am scenario). </p></li>
</ul>
<p>Correspondingly, the total hospital cost saving over the next 20 years is between: </p>
<ul>
<li><p>R326.8 million and R890.2 million (midnight scenario)</p></li>
<li><p>R130.5 million and R381.2 million (1am)</p></li>
<li><p>and between R18.7 million and R46.0 million (2am). </p></li>
</ul>
<p>(At the time of publication the <a href="https://www.xe.com/currencyconverter/convert/?Amount=1&From=USD&To=ZAR">exchange rate</a> was R19.42 to the US$) </p>
<p>In the year following the policy’s introduction, tax revenue (excise and value added tax) on alcohol sales is expected to decrease by between R100 million and R333 million under a midnight closing-time scenario. Under the 1am scenario it would fall by between R54 million and R179 million. And in the 2am scenario tax revenue would fall by between R9 million and R27 million. </p>
<p>Retail revenue would decrease by between R328 million and R1,093 million (midnight closing time), between R176 million and R587 million (1am) and between R27 million and R89 million (2am).</p>
<h2>What this all means</h2>
<p>The Western Cape government has expressed a clear commitment to protecting health in the Alcohol Harms Reduction <a href="https://www.westerncape.gov.za/text/2017/September/white_paper_alcohol-related_harms_reduction.pdf">White Paper</a>. Introducing uniform trading-time restrictions for onsite retailers of alcohol is a good first step. </p>
<p>A midnight closing time restriction is the most pro-health policy option.
A 2am closing time is the most pro-industry. But the <a href="https://dgmt.co.za/wp-content/uploads/2023/03/Trading-Hours-Phase-2-Modelling-Trading-Times-Final-Report-vf.pdf">research</a> does suggest that, from a public health standpoint, the 2am closing time still represents a modest improvement on the status quo.</p>
<p>Applying <a href="https://apps.who.int/iris/bitstream/handle/10665/259232/WHO-NMH-NVI-17.9-eng.pdf">evidence-based policies</a> to reduce alcohol consumption is necessary to reduce alcohol-related harms and deaths. The possibility of limited economic costs should not be a deterrent to this policy objective.</p>
<p>The alcohol industry may also point to the direct, indirect and induced job losses resulting from this policy. Concerns about employment losses are genuine and valid. But employment losses are only one side of the issue and should be considered with caution. One needs to consider the overall effects of the policy on employment. Jobs will be created in sectors attracting new demand as people spend some of their money on goods and services other than alcohol. It is nearly impossible to predict the number of jobs that will be created directly because of the policy, or because of the lives saved and lengthened.</p>
<h2>What more needs to be done</h2>
<p>Whatever closing time the government chooses, this policy won’t solve every problem. It will need to be enacted alongside other policy interventions geared towards reducing alcohol consumption and its associated harms. </p>
<p>These policies <a href="https://apps.who.int/iris/bitstream/handle/10665/259232/WHO-NMH-NVI-17.9-eng.pdf">include</a> banning alcohol advertising; adopting a minimum alcohol unit price; reducing the legal limits for drinking and driving; and making it easier for people to get counselling and medically assisted treatment if they struggle with alcohol dependence.</p>
<p>A comprehensive policy framework that targets alcohol consumption at an individual and societal level will be required to combat alcohol-related illness and death, and the adverse health, economic and social consequences.</p><img src="https://counter.theconversation.com/content/205700/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>This modelling study on which this article is based was commissioned and funded by the DG Murray Trust, an organisation which Sam has collaborated with as a consultant. Sam Filby works for the Research Unit on the Economics of Excisable Products based at the University of Cape Town. Her research conducted at the University of Cape Town is funded by the African Capacity Building Foundation through the Bill & Melinda Gates Foundation, Tax Justice Network Africa (also through the Bill & Melinda Gates Foundation), the CDC Foundation, and Cancer Research UK. Sam is also CIO of byegwaai, an app-based smoking cessation program. </span></em></p>Alcohol use contributes to over 200 different diseases, injuries, and conditions. It is also a risk factor for gender-based violence and violent crime.Sam Filby, Research Officer, Research Unit on the Economics of Excisable Products, University of Cape TownLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1845802022-07-26T14:51:49Z2022-07-26T14:51:49ZFacial injuries hurt Nigerians’ pockets too: how to reduce the burden<figure><img src="https://images.theconversation.com/files/468721/original/file-20220614-16-8qwx0x.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Road traffic crashes are the most common cause of facial injuries in Nigeria. </span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/photo/auto-accident-involving-two-cars-on-a-city-street-royalty-free-image/970958674?adppopup=true">Getty Images </a></span></figcaption></figure><p>Injury to the face – from road traffic accidents, for example – can leave a person with a damaged appearance or functional impairment, like difficulty chewing. Treatment helps to restore facial appearance and function and can give some psychological relief. </p>
<p>In Nigeria, facial injuries <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4329035/">account</a> for one out of every 10 bodily injuries. In <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8721415/">a study of 268 patients in Ghana</a>, motor vehicle accidents were the leading cause of mandibular fractures – 75.4%. Other causes included assault, gunshot, falls and industrial accidents. </p>
<p>The economic burden of treating facial injuries is large, and falls on the state and on those injured. For instance, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5020889/">the approximate cost</a> of treating lower jaw fractures of 50 patients in Kano State, north west Nigeria was N3,198,139 around US$7,698 in 2015. The overall health budget for the state <a href="https://drpcngr.org/wp-content/uploads/2021/04/KANO-STATE-HEALTH-BUDGET-PERFORMANCE-ANALYSIS-2015-2020.pdf">in 2015 was N18.75 billion (US$45 million)</a>. The gross national income per capita in <a href="https://www.statista.com/statistics/1291432/gross-national-income-per-capita-in-nigeria/">Nigeria for 2015 was US$2,820</a>. </p>
<p>It’s also a drain on patients and their caring relatives. In Nigeria, <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6186489/">payment for healthcare</a> is mostly an out-of-pocket expenditure. <a href="https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-05117-5#Bib1">Only about 10%</a> of the population had health insurance in 2020.</p>
<p>In most developed nations, healthcare services are funded by the government and various forms of health insurance schemes. For example, the hospital billing cost for treatment of lower jaw fractures in Seattle in the US was an average of <a href="https://pubmed.ncbi.nlm.nih.gov/22907110/">US$14,221 per patient in 2010</a>. Only one third of the Seattle patients were uninsured and had to individually pay for their treatments.</p>
<p>We carried out a study to determine the treatment cost of lower jaw fractures and methods of payment in Nigeria to evaluate the financial implications of facial injury. In <a href="https://link.springer.com/article/10.1007/s10006-021-01000-7">our study</a>, at least eight out of 10 patients paid between ₦42,900 (US$103) and ₦132,500 (US$319) out-of-pocket. Per capita income in the country for <a href="https://www.statista.com/statistics/1291432/gross-national-income-per-capita-in-nigeria/">2020 was US$2,000</a>. </p>
<p>Unsurprisingly, all the low-income patients were uninsured and were responsible for their treatment. This may result in financial hardship for individual patients and their households. </p>
<p>Measures to curtail this method of healthcare payment must be sought. Nigeria needs a better approach with sustained and massive funding to promote affordable access to quality healthcare.</p>
<h2>Causes and costs</h2>
<p>We collected data from the medical records and hospital billing sheets of 100 patients who were treated for lower jaw fractures. Just over 80% of the injuries were caused by automobile, bike and pedestrian accidents.</p>
<p><a href="https://www.statista.com/statistics/1296025/total-number-of-road-casualties-in-nigeria/#:%7E:text=More%20than%2011%2C800%20road%20traffic,1.7%20thousand%20were%20registered%20deaths.">More than 11,800 road traffic casualties</a> were reported in Nigeria during the fourth quarter of 2021. In the previous quarter, about 8,800 injuries and 1,400 deaths from road traffic crashes were counted in the country. Most road accidents occurring in Nigeria are classified as serious. Violations of rules about speed, road signs or vehicle lights were the <a href="https://www.statista.com/statistics/1296331/main-causes-of-road-accidents-in-nigeria-by-category/#:%7E:text=In%20Nigeria%2C%20road%20violations%20emanating,(SLV)%20caused%20312%20accidents.">leading causes of road traffic accidents</a>.</p>
<p>Assault was the cause of 12% of the injuries. </p>
<p>Only four of the patients in our study were in the low income bracket – possibly because low earners don’t usually go to a university teaching hospital. But 87% of all the patients were uninsured and paid the bills themselves, including all the low-income patients. </p>
<p>Direct treatment cost excludes other expenditure incurred while the patient is in the hospital. Transport fares of patients and their relatives, accommodation of relatives, and loss of income while out of work are among these other variable costs.</p>
<p>The direct treatment costs of broken lower jaws ranged between ₦42,900 (US$103) and ₦132,500 (US$319) as at January 2020. This may vary depending on the period and mode of treatment cost analysis in different health facilities in the country. The lowest treatment cost is still higher than the national minimum monthly wage <a href="https://www.premiumtimesng.com/news/headlines/507087-nigerias-minimum-wage-grossly-inadequate-cant-meet-basic-nutritional-needs-of-an-adult-report.html">of N30,000 (US$71.51)</a>.</p>
<h2>Funding of medical care</h2>
<p>Massive and sustained funding is essential to achieving universal health coverage. The national health insurance scheme was <a href="https://www.researchgate.net/publication/232246860_Nigerian_National_Health_Insurance_Scheme_NHIS_an_overview#:%7E:text=History%20of%20NHIS%20The%20Scheme,have%20been%20accredited%20and%20registered.">officially launched on 6 June 2005</a> to offer affordable and quality healthcare for all Nigerians irrespective of their socioeconomic, political and religious standing through multiple prepayment funds. It commenced operations in September 2005 and covered <a href="https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-020-05117-5#Bib1">about 10% of the population as at 2020</a>.</p>
<p>The basic package of Nigeria’s health insurance scheme would pay for some of the care received by patients with facial injuries. This is the minimum benefit available to all enrollees. Individual enrollees could subscribe to a different package with added benefits – and a higher premium – in both this scheme and private health insurance. </p>
<p>Other aspects of treatment not listed in the benefits package must be paid for by the patients. </p>
<p>Most enrollees on the national health insurance scheme are government employees who belong to the middle- and high-income classes. </p>
<p>Community health insurance is a social health insurance programme for the informal sector with <a href="https://www.njcponline.com/article.asp?issn=1119-3077;year=2015;volume=18;issue=4;spage=437;epage=444;aulast=uzochukwu">about 1% coverage</a>. Reasons for low coverage include unaffordable premiums, unattractive benefit packages, and <a href="https://www.njcponline.com/article.asp?issn=1119-3077;year=2015;volume=18;issue=4;spage=437;epage=444;aulast=uzochukwu">mistrust between policy managers and potential enrollees</a>.</p>
<p>The out-of-pocket model of healthcare financing is prevalent in sub-Saharan Africa and other low- and middle-income countries with poor government healthcare expenditures.</p>
<p>The high incidence of out-of-pocket payment leaves the poor poorer. <a href="https://www.ajol.info/index.php/jcmphc/article/view/194172">Other consequences</a> include delays in seeking quality healthcare and the incentive to patronise unqualified providers. </p>
<p>The gaps in financial risk protection for the economically vulnerable could <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4370156/">leave</a> households in financial distress. </p>
<h2>Steps to take</h2>
<p>Prevention of injury is one step. Since road traffic crashes are the most <a href="https://journals.sagepub.com/doi/abs/10.1055/s-0034-1384740">common cause</a> of facial injury in Nigeria, the <a href="https://frsc.gov.ng/">Federal Road Safety Commission</a> and other relevant government agencies should educate the public about the importance of seat belts and protective headgear. It has been shown that <a href="https://pubmed.ncbi.nlm.nih.gov/27441732/">these reduce injuries</a>. </p>
<p>Government should also increase health insurance coverage through massive public engagement on the benefits of health insurance. It should provide long-term loans for community and private health insurance schemes in order to make the premiums affordable for more people. <a href="https://pubmed.ncbi.nlm.nih.gov/23339606/">Ghana’s system</a> is a good example.</p>
<p>All health insurance schemes in the country should offer enrollees a basic healthcare package that would be affordable to low-income Nigerians. Claims should receive prompt and transparent attention from the policy managers of insurance companies. This will encourage people to join the health insurance schemes and keep up their payments.</p><img src="https://counter.theconversation.com/content/184580/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bamidele Famurewa does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>More Nigerians should be encouraged to have health insurance to reduce the burden of treating facial injuries.Bamidele Famurewa, Lecturer and Consultant in Oral and Maxillofacial Surgery, Obafemi Awolowo UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/835692017-09-10T19:44:08Z2017-09-10T19:44:08ZMore cyclists are ending up in hospital with serious injuries, so we need to act now<figure><img src="https://images.theconversation.com/files/185200/original/file-20170908-9945-14aeavv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Serious injury rates are rising in cyclists, and are associated with significant disability and economic costs. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/573221677?src=ZUl0Yi1m8YYIQIdspWj5Gg-1-0&size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>Cyclists are suffering more serious injuries in road crashes than ever before, leading to significant disability, our <a href="https://www.mja.com.au/journal/2017/207/6/road-safety-serious-injuries-remain-major-unsolved-problem">new study</a> shows.</p>
<p>But what is less clear is what’s behind these injuries, which are occurring as the number of people who died in road traffic crashes has fallen.</p>
<p>In our study published today in the <a href="https://www.mja.com.au/journal/2017/207/6/road-safety-serious-injuries-remain-major-unsolved-problem">Medical Journal of Australia</a>, we investigated deaths and serious injuries after traffic crashes in Victoria from 2007 to 2015.</p>
<p>We looked at whether deaths and serious injury rates for all road users changed over time. We also looked at the disability and economic costs of these injuries.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/people-take-to-their-bikes-when-we-make-it-safer-and-easier-for-them-82251">People take to their bikes when we make it safer and easier for them</a>
</strong>
</em>
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<hr>
<p>The total number of deaths from road traffic crashes fell over the study period. But rates of serious road traffic injuries did not.</p>
<p>There were 10,092 road traffic deaths and serious injuries over the course of our study. This led to over 77,000 disability-adjusted life years (a measure of overall disability burden, expressed as the number of years lost to disability or early death). </p>
<p>The estimated health costs associated with these road traffic injuries (known as “health loss” costs) was more than A$14 billion.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/185197/original/file-20170907-9945-1vtpztn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/185197/original/file-20170907-9945-1vtpztn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/185197/original/file-20170907-9945-1vtpztn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=337&fit=crop&dpr=1 600w, https://images.theconversation.com/files/185197/original/file-20170907-9945-1vtpztn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=337&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/185197/original/file-20170907-9945-1vtpztn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=337&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/185197/original/file-20170907-9945-1vtpztn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=424&fit=crop&dpr=1 754w, https://images.theconversation.com/files/185197/original/file-20170907-9945-1vtpztn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=424&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/185197/original/file-20170907-9945-1vtpztn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=424&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">The rates of crashes resulting in serious injury in cyclists rose 8% a year.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/399077320?src=KpKNqkCaCkQBh_w3M3u2jw-1-0&size=medium_jpg">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>Most concerning was the rise in serious injury rates in cyclists, which increased 8% a year. In fact, the absolute number of cases more than doubled over the nine-year study period. </p>
<p>These injuries are often severe, including head injuries, spine injuries and fractures of the pelvis and limbs. They often lead to significant disability.</p>
<p>Over the course of our study, a rise in such serious injuries led to a 56% increase in disability-adjusted life years; health costs for cyclists were more than A$700 million.</p>
<h2>Why are cyclists’ serious injuries rising?</h2>
<p>However, it is not clear what’s driving these increases in serious injuries.</p>
<p>In a <a href="http://www.sciencedirect.com/science/article/pii/S0001457516302950">previous study</a>, we interviewed cyclists admitted to hospital after a crash. Of the crashes that occurred on the road, 52% involved another road user, most commonly a motor vehicle.</p>
<p>A total of 22% of all on-road crashes also occurred while cyclists were riding in a marked bicycle lane, demonstrating they are not sufficient to completely protect cyclists. While these on-road bicycle lanes provide dedicated space for cyclists, riders remain close to motorists, and people in parked cars opening doors. </p>
<p>A total of 48% of on-road crashes only involved a single cyclist. While we need more research to better understand the single cyclist-only crashes, <a href="https://trid.trb.org/view.aspx?id=1343699">researchers have previously found</a> the condition of road surfaces, distraction, mechanical issues and speed are possible factors.</p>
<h2>Are more people cycling?</h2>
<p>One of the limitations of our study was that we couldn’t adjust for the amount of time or distance cyclists travel each year. Unfortunately, we have very limited data on this in Australia. </p>
<p>The <a href="http://www.bicyclecouncil.com.au/publication/national-cycling-participation-survey-2017">National Cycling Participation Survey</a> is a telephone survey that asks how many times people cycled in the past week, month or year. The 2017 results showed the proportion of people who had cycled in the past month declined from 27% in 2011 to 22% in 2017. </p>
<p>While cycling participation overall may have declined, there may be an increase in the overall time spent riding, or the number of cyclists riding on the road, compared to on bicycle paths, for example.</p>
<h2>So, what does this mean for cyclists?</h2>
<p>So, is the message from our study, “don’t cycle”? No, not at all. The health and economic benefits of cycling are well established. A <a href="http://www.bmj.com/content/357/bmj.j1456">recent UK study</a> demonstrated that cycling to work was associated with a 41% lower risk of early death compared to commuting by car or public transport.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/better-health-is-only-a-short-bike-ride-away-3613">Better health is only a short bike ride away</a>
</strong>
</em>
</p>
<hr>
<p>And while cycling-related injury rates are on the rise, they made up only 11% of serious road traffic injuries.</p>
<p>It is clear we need greater investment in cyclist safety. We know being concerned about safety is one of the <a href="https://www.heartfoundation.org.au/images/uploads/publications/Cycling-Survey-2011-Riding-a-Bike-for-Transport.pdf">biggest barriers</a> to people cycling. </p>
<p>Interactions with motor vehicles – not just collisions, but also being in the presence of and close proximity to motor vehicles – and the absence of appropriate cycling infrastructure are some of the most common barriers people mention.</p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/cars-bicycles-and-the-fatal-myth-of-equal-reciprocity-81034">Cars, bicycles and the fatal myth of equal reciprocity</a>
</strong>
</em>
</p>
<hr>
<p>Dedicated bike lanes that are separated from traffic are <a href="http://injuryprevention.bmj.com/content/19/5/303">an effective way</a> to reduce serious injury. </p>
<p>While we need to invest more in cycling-specific infrastructure (like bike lanes and bike paths) it is often not feasible to have this across an entire road network. So, we need a multi-faceted approach to improving safety for cyclists. </p>
<p>Reducing the speed limit in residential streets to 30km/h has been proposed as a way to improve safety for vulnerable road users, and a <a href="https://www.yarracity.vic.gov.au/news/2017/09/05/yarra-to-introduce-30kmh-speed-trial">trial</a> has recently been announced in inner Melbourne. </p>
<p>We also need to improve the culture around cyclists as legitimate road users, through changes in legislation, education and training for all road users.</p>
<p>Given the rising injury rates in cyclists, we need government and road safety organisations to act now to provide a safer environment for cyclists.</p><img src="https://counter.theconversation.com/content/83569/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Ben Beck receives funding from the National Health and Medical Research Council. The Victorian State Trauma Registry is funded by the Department of Health and Human Services, the state Government of Victoria and the Transport Accident Commission.</span></em></p>More cyclists are suffering from serious injuries than ever before. Here’s what we can do to provide a safer environment.Ben Beck, Research fellow, Monash UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/823832017-08-28T20:06:13Z2017-08-28T20:06:13ZRethinking the causes of road trauma: society’s problems must share the blame<figure><img src="https://images.theconversation.com/files/182353/original/file-20170817-16211-1jvhls1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Road trauma is already the ninth leading cause of death worldwide.</span> <span class="attribution"><span class="source">AAP/Alan Porritt</span></span></figcaption></figure><p>After years of consistent progress, reductions in the road toll are plateauing in many countries. Australia’s road fatalities increased by 7.5% in 2016, and the number of fatalities per 100,000 population rose by 6%. This trend appears to be continuing <a href="https://bitre.gov.au/publications/ongoing/road_deaths_australia_monthly_bulletins.aspx">in 2017</a>. </p>
<p>Road trauma is already the ninth leading cause of death worldwide. It <a href="http://www.who.int/violence_injury_prevention/key_facts/VIP_key_fact_3.pdf">is estimated</a> it will be one of the top five killers by 2030.</p>
<iframe src="https://datawrapper.dwcdn.net/Akc4L/1/" scrolling="no" frameborder="0" allowtransparency="true" allowfullscreen="allowfullscreen" webkitallowfullscreen="webkitallowfullscreen" mozallowfullscreen="mozallowfullscreen" oallowfullscreen="oallowfullscreen" msallowfullscreen="msallowfullscreen" width="100%" height="400"></iframe>
<p>In efforts to stem road trauma, the global road safety community has promoted what it calls <a href="http://roadsafety.gov.au/nrss/safe-system.aspx">“safe systems” approaches</a>. These cover:</p>
<ul>
<li><p>improved road safety management; </p></li>
<li><p>safer roads; </p></li>
<li><p>safer vehicles; </p></li>
<li><p>safer road users; and</p></li>
<li><p>improved post-crash response systems. </p></li>
</ul>
<p>In Queensland, enforcement and education campaigns aim to prevent the <a href="https://www.police.qld.gov.au/EventsandAlerts/campaigns/fatalfive.htm">“fatal five”</a> behaviours known to underpin road trauma: </p>
<ul>
<li><p>drug and drink driving; </p></li>
<li><p>distraction and inattention; </p></li>
<li><p>failure to wear a seatbelt; </p></li>
<li><p>speeding; and </p></li>
<li><p>fatigue. </p></li>
</ul>
<p>Assuming some drivers will still engage in these behaviours, efforts also focus on how vehicles, road environments and trauma and rehabilitation services can be modified to reduce the likelihood of death and serious injury in a crash.</p>
<p>This approach has achieved considerable, undeniable success. But it may have reached its limits of effectiveness.</p>
<h2>Why isn’t this approach working any more?</h2>
<p>Fundamentally, the current “safe systems” approach is based on reductionism: that is, the road transport system is artificially isolated from its broader environment and broken into even smaller, discrete parts (such as road users, vehicles and roads). </p>
<p>Attempts are then made to optimise these parts under the assumption that once they are all put back together, the system will naturally perform better. </p>
<p>But complex systems, which are far more than the sum of their parts, do not operate like that. Instead, modified parts interact with other parts in new ways and unexpected emergent behaviours can occur. Factors across the system might also resist change, bringing the modified parts back to their original state, or creating new issues that arise from previous solutions. </p>
<p>Finally, and perhaps most importantly, things extrinsic to the system itself can influence the behaviour of the individual parts. </p>
<p>For most people, driving is simply a means to an end, and something that is affected by the pressures of life and work. There are wider societal issues driving road user behaviour that a traditional road safety approach cannot fix.</p>
<p>For example, take driving under the influence of illicit or prescription drugs, which is an <a href="http://apps.who.int/iris/bitstream/10665/249533/1/WHO-MSD-NVI-2016.01-eng.pdf?ua=1">emerging road safety problem</a>. </p>
<p>Drug misuse and addiction are both societal issues that road safety authorities attempt to manage through enforcement and education campaigns. But the current road safety approach does not tackle the underlying issue of drug misuse and addiction. Rather, it simply identifies and removes drug-affected drivers from the road. </p>
<p>This approach is based on causal loop logic, such as that presented below. The diagram suggests a mechanism whereby drug-related crashes and fatalities lead to policy action, which then drives increased enforcement. </p>
<p>The diagram illustrates the belief that identifying drug-affected drivers and removing them from the road will lead to a decrease in the number of drug-affected drivers and related crashes. </p>
<p>But what’s important to note in this representation is that nowhere are societal problems of drug misuse and addiction tackled.</p>
<hr>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/182926/original/file-20170822-30552-zi35y3.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/182926/original/file-20170822-30552-zi35y3.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=592&fit=crop&dpr=1 600w, https://images.theconversation.com/files/182926/original/file-20170822-30552-zi35y3.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=592&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/182926/original/file-20170822-30552-zi35y3.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=592&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/182926/original/file-20170822-30552-zi35y3.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=744&fit=crop&dpr=1 754w, https://images.theconversation.com/files/182926/original/file-20170822-30552-zi35y3.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=744&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/182926/original/file-20170822-30552-zi35y3.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=744&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Author provided/The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nc/4.0/">CC BY-NC</a></span>
</figcaption>
</figure>
<hr>
<p>Although drug-affected drivers will continue to be caught and penalised, they are not rehabilitated, and little is done to tackle wider societal issues that contribute to drug misuse and addiction. As such, we can only expect a continued flow of drug-affected drivers onto our roads. </p>
<p>The same applies for other “fatal five” behaviours, which each have societal drivers. For example, increasing levels of alcohol consumption influence drink-driving rates, an increasing desire to remain connected through mobile phones influences distraction and inattention, increasingly time-poor lifestyles lead to speeding, and work pressures lead to fatigued driving.</p>
<p>Even the very requirement to drive a car in the first place is driven by low-density urban form and lack of viable public transport.</p>
<h2>What is the solution?</h2>
<p>The safe-systems view of road safety, which defines the boundaries of the road system as drivers, vehicles and roads, has largely run its course. </p>
<p>A new, systems-thinking-based approach is required that considers the broader societal systems whose effects manifest inside the road system. This requires the breakdown of silos between the fields of public health, workplace safety, urban planning and road safety.</p>
<p>With drug driving, for example, road safety stakeholders should co-ordinate their activities with those tackling drug misuse and addiction. </p>
<p>In the case of prescription drugs, government, the media, drug manufacturers, pharmaceutical companies, doctors, healthcare providers and the police should all be working together through active collaboration.</p>
<p>Prescription rates, drug packaging, alternative pain treatments and rehabilitation should be co-ordinated with modifications to road safety strategy, road rules and regulations, licensing, road user testing, education and enforcement. </p>
<p>This systems-thinking approach is represented below. The earlier causal loop diagram has been modified to show some of the wider influences on, and potential solutions for, drug-driving.</p>
<hr>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/183255/original/file-20170824-25621-1nx8nnc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/183255/original/file-20170824-25621-1nx8nnc.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=434&fit=crop&dpr=1 600w, https://images.theconversation.com/files/183255/original/file-20170824-25621-1nx8nnc.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=434&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/183255/original/file-20170824-25621-1nx8nnc.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=434&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/183255/original/file-20170824-25621-1nx8nnc.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=546&fit=crop&dpr=1 754w, https://images.theconversation.com/files/183255/original/file-20170824-25621-1nx8nnc.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=546&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/183255/original/file-20170824-25621-1nx8nnc.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=546&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption"></span>
<span class="attribution"><span class="source">Author provided/The Conversation</span>, <a class="license" href="http://creativecommons.org/licenses/by-nd/4.0/">CC BY-ND</a></span>
</figcaption>
</figure>
<hr>
<p>Encouragingly, there is a groundswell of research that is beginning to apply systems-thinking methods to <a href="http://www.sciencedirect.com/science/article/pii/S0965856415002517">road safety</a>. Researchers and practitioners are realising the need to look beyond the road transport system and work with those in other areas.</p>
<p>While we should not forget the significant and tangible impact that road safety stakeholders have achieved, it’s time to acknowledge that road trauma is a complex problem that cannot be solved by them alone.</p><img src="https://counter.theconversation.com/content/82383/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Paul Salmon receives funding from the Australian Research Council.</span></em></p><p class="fine-print"><em><span>Adam Hulme, Gemma Read, Jason Thompson, and Roderick McClure do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Wider societal issues are driving road user behaviour, which cannot be fixed by taking a traditional road safety approach.Paul Salmon, Professor of Human Factors, University of the Sunshine CoastAdam Hulme, Research Fellow, University of the Sunshine CoastGemma Read, Research Fellow in Human Factors & Sociotechnical Systems, University of the Sunshine CoastJason Thompson, Senior Research Fellow, The University of MelbourneRoderick McClure, Head, School of Rural Medicine, University of New EnglandLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/806682017-07-25T20:08:31Z2017-07-25T20:08:31ZPersonal injury insurers are at risk of crashing in the transport systems of tomorrow<figure><img src="https://images.theconversation.com/files/178763/original/file-20170719-31776-1en6k9r.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Australia has a series of transport injury insurance, compensation and rehabilitation schemes.</span> <span class="attribution"><span class="source">AAP/Alan Porritt</span></span></figcaption></figure><p>Between 1955 and 1976, Australian private vehicle ownership <a href="http://www.abs.gov.au/AUSSTATS/abs@.nsf/DetailsPage/9309.030%20September%201976?OpenDocument">more than tripled</a>. This period produced improved population mobility. However, it also created a continuing human and financial toll generated by road trauma.</p>
<p>In response, Australia developed a series of transport injury insurance, compensation and rehabilitation schemes funded by compulsory third-party premiums attached to vehicle registrations.</p>
<p>Since then, schemes such as the TAC have played a crucial role in ensuring Australia’s transport and health systems continue to function while effectively mopping up the more than A$5 billion in annual injury costs <a href="https://www.google.com.au/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwiDqsbfgaHVAhWClJQKHTzjAt8QFggoMAA&url=http%3A%2F%2Fwww.tac.vic.gov.au%2F__data%2Fassets%2Fpdf_file%2F0006%2F206169%2FTAC_Annual_Report_2016_web-FINAL.pdf&usg=AFQjCNEbNOxJ4PGtlEClVzdP_B21coNMAA">generated by road crashes</a>.</p>
<p>However, the time for Australia’s personal injury insurance schemes to start preparing for change is now. Here’s why.</p>
<h2>What are these schemes for?</h2>
<p>Injury insurance, compensation and rehabilitation schemes pay for emergency services, trauma and hospital care, psychological care, GP visits, medications, wage replacement, and a host of other supports to injured people and their families.</p>
<p>In some circumstances, they also allow injured road-users to sue at-fault drivers for common law damages.</p>
<p>Through continued investment in administrative efficiencies and injury prevention, schemes also attempt to keep a lid on the cost of premiums paid for by motorists. Therefore, while exact design differs between jurisdictions, broadly, each scheme promotes an emphasis on:</p>
<ul>
<li><p>maintaining reasonable cost of premiums for motorists;</p></li>
<li><p>responding to clients’ non-medical expectations of service; and</p></li>
<li><p>improving health outcomes for injured clients.</p></li>
</ul>
<p>However, achieving multiple performance goals is challenging – especially in the face of rapid external social and technological change.</p>
<p>For example, in 1986, the failure of Victoria’s Motor Accident Board to adjust to the “era of mass motor vehicle usage” brought about <a href="http://www.iscrr.com.au/__data/assets/pdf_file/0009/297180/To-strike-a-balance-WorkSafe-History.pdf">its collapse</a>. At closure, the board experienced widespread fraud, provided poor support for injured people, held outstanding liabilities of $2.6 billion, and had revenue shortfalls of more than $200 per registered vehicle.</p>
<p>Similarly, the New South Wales government recently <a href="https://www.google.com.au/url?sa=t&rct=j&q=&esrc=s&source=web&cd=1&cad=rja&uact=8&ved=0ahUKEwjc6LnIgqHVAhXBmpQKHZHXCY0QFggkMAA&url=http%3A%2F%2Fwww.sira.nsw.gov.au%2F__data%2Fassets%2Fpdf_file%2F0018%2F95400%2FCTP-Reform-options-paper-final.pdf&usg=AFQjCNGPSFdp4Rx-4quT7KrqB3iFOR1F4w">invited comment</a> on the redesign of its compulsory third-party insurance scheme. It cited significant challenges including increased injury claim volumes, fraudulent and exaggerated claims, inefficient distribution of funds to injured people, and lengthy claim resolution processes.</p>
<p>NSW is attempting to redesign its scheme to optimise affordability, health outcomes, and system responsiveness in the face of an uncertain, dynamic and complex transportation and legal environment.</p>
<p>As these examples illustrate, schemes must have confidence in predicting levels of road trauma produced by the transport system, and the costs of rehabilitation and common law cases associated with claims.</p>
<p>Against this, expected revenue gathered from insurance premiums and investment returns must be balanced. However, the predictability of these equations may be about to change radically.</p>
<h2>The need for change</h2>
<p>Australia’s transport system finds itself on the precipice of a technological and social revolution. The combined rise of <a href="https://theconversation.com/self-driving-cars-must-learn-trust-and-cooperation-79484">autonomous vehicles</a> and the <a href="https://theconversation.com/in-love-with-uber-and-airbnb-you-might-have-disruption-fever-49592">sharing economy</a> is coalescing into a potentially positive – yet uncertain – future for transport system design.</p>
<p>In turn, this should ring alarm bells for injury insurance, compensation and rehabilitation schemes whose operational models reflect current, rather than future, transport system structures. The former are based on human drivers, private car use, private car ownership, registration-linked premium collection, and personal liability for the consequences of road crashes.</p>
<p>In future, though, there may be the introduction of autonomous vehicles not “driven” by owners or no longer “owned” by individuals at all. This could lead to a reduction in the total vehicle road-going fleet, and a decrease in the amount compulsory third-party premium revenues. </p>
<p>Finally, this could lead to the hiking of premiums for those left in the system without access to autonomous vehicles. These would potentially be people on low-incomes or motorcycles, creating a virtually uninsurable “self-driving” population.</p>
<p>And, in the case of common law damages, who would be the target of litigation? The manufacturer? The autonomous vehicle user?</p>
<p>It is hard to imagine users agreeing to accept liability on behalf of an autonomous vehicle manufacturer any more than you would take on risk for your taxi driver.</p>
<p>However, autonomous vehicles are often hailed for their <a href="http://bigthink.com/ideafeed/googles-self-driving-car-is-ridiculously-safe">potential safety benefits</a> – which may yet prove correct. If a future containing autonomous vehicles no longer contains road crashes, then personal injury insurers may no longer be required. But the road to that utopia contains many twists and turns, not all of which we can foresee.</p>
<p>What we do know is that around 1,300 people still die, and tens of thousands more are injured, on Australian roads <a href="https://bitre.gov.au/statistics/safety/fatal_road_crash_database.aspx">every year</a>. Australians pay around $700 per vehicle per year to ensure their medical bills and rehabilitation costs will be looked after in the event of a crash. </p>
<p>It is unclear how autonomous vehicles will reshape the transportation sector. It is therefore unclear how this will affect the operational model of the multi-billion-dollar personal injury insurance industry that underpins it. But if schemes cannot adapt to the transition, the functionality of the whole transport system is at risk.</p><img src="https://counter.theconversation.com/content/80668/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Jason Thompson does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>It’s time for Australia’s personal injury insurance schemes to start preparing for change.Jason Thompson, Senior Research Fellow, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/748452017-04-10T20:11:18Z2017-04-10T20:11:18ZYes, car seats protect children. But you need the right restraint, fitted properly<figure><img src="https://images.theconversation.com/files/164400/original/image-20170407-29399-1kf15c0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Laws introduced in 2009 and 2010 stipulate specific car restraints for children of different ages. </span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/71104492?src=hFKOGdz-r4UQxvPRJB3M_g-1-3&size=huge_jpg">from www.shutterstock.com </a></span></figcaption></figure><p>Road transport accidents remain a leading cause of death, with between <a href="http://www.aihw.gov.au/WorkArea/DownloadAsset.aspx?id=10737423340">one and two in every 100,000 Australian children</a> dying on our roads each year. </p>
<p>There is no doubt using a restraint protects against harm during a crash. In Australia we have seen <a href="https://search.informit.org/documentSummary;dn=569711338424475;res=IELHEA;subject=Health">steady declines in death and injury</a> among children in cars since the late 1970s, when laws requiring children to buckle up in cars were first introduced.</p>
<p>But just having a restraint available is not enough. In terms of risk of death and injury, the <a href="http://pediatrics.aappublications.org/content/early/2010/01/11/peds.2009-1171">protection provided to children</a> in a crash progressively increases from simply having them restrained, to having them restrained in an age appropriate restraint, to having them restrained correctly in an age appropriate restraint. </p>
<p><a href="http://www.sciencedirect.com/science/article/pii/S0001457510001946">One in every two</a> restrained children travelling in cars in NSW has at least one error in how the restraint is being used. </p>
<h2>The physics of car crash survival</h2>
<p>Modern vehicles are designed to reduce crash forces on occupants by absorbing some of the crash energy. Restraint systems protect passengers in crashes by effectively tying them as tightly as possible to the car. This prevents excess movement, and allows passengers to make the best use of safety features built into modern cars. </p>
<p>These features aim to ensure that in a crash, passengers come to a stop over the longest possible distance, reducing the force and therefore risk and severity of injury in a crash. </p>
<p>But in tying the passenger to the car, it’s important the forces applied to the body are distributed over the strongest parts of the body, and that the motion of the body is controlled. This is where design of child restraints comes in.</p>
<h2>Different seats for different kids</h2>
<p>Laws were introduced across Australia in 2009 and 2010 that stipulated <a href="http://www.austlii.edu.au/au/legis/sa/consol_reg/arr210/s266.html">the exact type of restraint</a> that should be used by children of different ages. The laws vary slightly from state to state, but generally these require:</p>
<ul>
<li>children up to at least 6 months of age use a rearward facing infant restraint</li>
<li>children up to at least 4 years use a forward facing child seat with in-built harness, and </li>
<li>children up to at least 7 years use a booster seat. </li>
</ul>
<figure>
<iframe width="440" height="260" src="https://www.youtube.com/embed/pdkZ-ZDxwtA?wmode=transparent&start=0" frameborder="0" allowfullscreen=""></iframe>
<figcaption><span class="caption">Different sized children need different types of car seats, or restraints.</span></figcaption>
</figure>
<p>Since then we’ve seen <a href="http://onlinelibrary.wiley.com/doi/10.1111/1753-6405.12070/abstract">improvements in the numbers</a> of children using the right type of restraint. </p>
<p>While there has not yet been any rigorous evaluation of the impact of these laws on crash injury, they are linked with a reduction in fatalities. Figures from the <a href="https://bitre.gov.au/statistics/safety/fatal_road_crash_database.aspx">Bureau of Infrastructure, Transport and Regional Economics</a> show that before the new laws, on average, about 70 children died every year in Australia in car crashes. The average number of child passengers dying each year is now around 40.</p>
<h2>Using the restraint properly</h2>
<p>To get the best possible protection in a crash, restraints need to be used correctly. <a href="http://www.sciencedirect.com/science/article/pii/S0001457510001946">One in every two</a> restrained children travelling in cars in NSW has at least one error in how the restraint is being used. </p>
<p>There are three broad types of errors that occur when children use restraints:</p>
<ol>
<li>errors in the way the restraint is installed in the vehicle</li>
<li>errors in the way children are secured within the restraint, and </li>
<li>errors that are introduced by children while they travel in the car. </li>
</ol>
<p>Errors are often present even when parents are confident in their ability to correctly use restraints. Sometimes parents are aware of the errors, but don’t realise the potential negative impact. </p>
<p>The biggest problem is when the error loosens how tightly the child is tied to the vehicle. This includes slack in the belts tying the restraint to the car, or the harness tying the child to the restraint, and when the harness or belt is not placed over the correct parts of the body. </p>
<p>The latter commonly occurs when the harness (or seat belt in a booster seat) is not used correctly either because the parent has not secured the child correctly or the child removes their arms during travel.</p>
<figure class="align-left ">
<img alt="" src="https://images.theconversation.com/files/164636/original/image-20170410-27621-yotf22.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/164636/original/image-20170410-27621-yotf22.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/164636/original/image-20170410-27621-yotf22.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/164636/original/image-20170410-27621-yotf22.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/164636/original/image-20170410-27621-yotf22.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/164636/original/image-20170410-27621-yotf22.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/164636/original/image-20170410-27621-yotf22.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">In the lap of luxury…and safety.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/162411116?src=wqy3XuO_13lVf_iFP7iexg-2-30&size=huge_jpg">from www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>The new laws of 2009 and 2010 have been followed by a slight increase in correct use of child restraints. In children aged two to five years in low socioeconomic areas of Sydney, we saw correct use <a href="http://onlinelibrary.wiley.com/doi/10.1111/1753-6405.12070/abstract">increase from 36% to 47%</a> in 2010, just after the introduction of the new laws.</p>
<h2>I need help!</h2>
<p><a href="http://roadsafety.transport.nsw.gov.au/cgi-bin/index.cgi?action=authrestraintfitting.form">Restraint Fitting Stations</a>, and restraint fitting check days run by local governments and safety stakeholders can help parents make sure restraints are installed correctly, and can also provide advice about how to correctly secure their children within restraints. </p>
<p>We have found that children of parents who had not used these services were <a href="http://www.sciencedirect.com/science/article/pii/S0001457510003982">twice as likely</a> as other children to be incorrectly restrained. But these services can’t be on hand to check restraints every day when parents need to move children between cars or when the restraint settings need to be modified as children grow. </p>
<p>In these circumstances the best available information is the information supplied with the restraint. But parents currently find this information <a href="http://search.informit.com.au/documentSummary;dn=445046962727704;res=IELHEA">difficult to use, and difficult to understand</a>. And neither of these measures addresses the interaction between the child and the restraint.</p>
<p>Information supplied with child restraint systems should be be user friendly – for all users, including those with lower levels of English literacy. Restraint systems must also be easier to use. Many current restraints are not intuitively easy to use, and sometimes physically difficult to use correctly. </p>
<p>As child safety advocates we need to shift our focus again. Instead of focusing on encouraging parents to use restraints correctly, let’s focus on working with industry to ensure information supplied with child restraints is comprehensible, and to improve restraint design so they’re actually difficult to use incorrectly.</p>
<hr>
<p><em>For more information on how to choose the right restraint type, and to use it correctly see <a href="https://www.childcarseats.com.au/">Child Car Seats</a></em></p>
<p><em>To take part in the child restraint research program at Neura, visit <a href="https://www.neura.edu.au/">www.neura.edu.au</a></em></p><img src="https://counter.theconversation.com/content/74845/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Julie Brown receives funding from the National Health & Medical Research Council, the Australian Research Council, State Road Authorities and is conducting research to address usability of child restraints in partnership with Australian child restraint manufacturers. She is the former Chair, and current Vice Chair of Kidsafe NSW.</span></em></p>Car seats and their endless harnesses, straps and buckles feel like an engineering nightmare for parents. But they work.Julie Brown, Senior Research Fellow , Neuroscience Research AustraliaLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/624952016-07-15T00:40:45Z2016-07-15T00:40:45ZShould Tesla’s autopilot cars be allowed on public roads following accidents?<p>Humans are terrible at driving. The US Department of Transport estimates that <a href="http://www.nhtsa.gov/About+NHTSA/Press+Releases/2015/2014-traffic-deaths-drop-but-2015-trending-higher">94% of crashes</a> are due to the driver. </p>
<p>We drive too fast. We get distracted. We make poor decisions.</p>
<p>If <a href="https://bitre.gov.au/statistics/safety/fatal_road_crash_database.aspx">history is anything to go by</a>, more than 1,000 people are likely to die on Australian roads in the next year. Each death is a tragedy for the families and friends of those killed. </p>
<p>And it’s also a big drain on our economy. Each fatal accident costs <a href="https://bitre.gov.au/publications/2010/report_118.aspx">around $2 million</a>. The total cost on our economy from all car accidents is more than $17 billion per year.</p>
<p>Autonomous cars are going to be <a href="https://www.technologyreview.com/s/520746/data-shows-googles-robot-cars-are-smoother-safer-drivers-than-you-or-i/">far better drivers</a>. There is therefore a moral imperative to get them onto our roads as soon as possible.</p>
<p>They will also bring many other benefits such as reducing congestion, lowering transport costs and bringing personal mobility to the elderly, disabled and young.</p>
<p>Tesla, more than any car company, has been <a href="http://www.wired.com/2015/10/tesla-self-driving-over-air-update-live/">pushing the field</a>. Its technology is impressive and improving rapidly.</p>
<h2>Accidents</h2>
<p>Accidents are, however, happening at an increasing rate as autonomous cars become more common.</p>
<p>On Valentine’s Day this year, one of Google’s autonomous cars <a href="http://www.wired.com/2015/10/tesla-self-driving-over-air-update-live/">caused its first crash</a> when it pulled out in front of a bus. Fortunately, no one was hurt.</p>
<p>Just three months later, on May 7, a Tesla S driving autonomously on a 65mph (about 105kmh) limit road <a href="https://www.theguardian.com/technology/2016/jun/30/tesla-autopilot-death-self-driving-car-elon-musk">drove into a truck</a> turning across the highway. The driver, Joshua Brown, who was sitting in the driving seat of the Tesla was killed. <a href="http://bigstory.ap.org/article/ee71bd075fb948308727b4bbff7b3ad8/self-driving-car-driver-died-after-crash-florida-first">According to reports</a>, he was watching a Harry Potter movie. </p>
<p>What actually happened in the lead up to the accident is currently under investigation.</p>
<p>Tesla <a href="https://www.teslamotors.com/blog/tragic-loss">issued a statement</a>, acknowledging the tragic loss, and saying their instructions require drivers who engage the autopilot mode to monitor the road and be ready to take back control at short notice. </p>
<p>And last Sunday in the US, <a href="http://www.bbc.co.uk/news/technology-36783345">a second Tesla car crashed</a> while being used autonomously. No one was injured. But how long before a Tesla car kills an innocent member of the public, a pedestrian or person in another vehicle?</p>
<h2>Public safety</h2>
<p>Silicon Valley’s <a href="https://www.theguardian.com/technology/2014/jun/28/silicon-valley-startup-failure-culture-success-myth">“fail fast” culture</a> may work for Facebook. No one is likely to be seriously hurt when their news feed is messed up. But fail fast is too risky for public safety.</p>
<p>Is it responsible for Tesla to release this technology into the wild when serious questions surround its safety?</p>
<p>Will the human driver monitor the road adequately? Will a human driver be able to take back control quickly enough? </p>
<p>It is not sufficient that the human driver gave consent; the rest of us using the roads have not given our consent. </p>
<p>Since human lives are at stake, drug companies do not get to test their new products on the general population. Should car companies be allowed to do so? </p>
<p>Tesla plans to put out a <a href="https://www.theguardian.com/technology/2016/jul/12/tesla-car-crash-montana-elon-musk-self-driving-cars">blog post to educate Tesla owners</a> on how to use the autonomous features of their cars safely. I doubt this is enough. </p>
<p>The US Department of Transportation’s National Highway Traffic Safety Administration (NHTSA) has defined <a href="http://www.nhtsa.gov/About+NHTSA/Press+Releases/U.S.+Department+of+Transportation+Releases+Policy+on+Automated+Vehicle+Development">five different levels of autonomous driving</a>, ranging from zero to four (level zero is where the driver remains in control at all times). </p>
<p>Should level three autonomy be allowed where a human driver may be required to take back control at any moment? Or should we only allow level four where the system will work safely even if the human driver fails to take back control promptly.</p>
<p>Should Tesla be allowed to push updates out without extensive testing?</p>
<p>On average, one person dies for every 100 million miles (160 million kilometres) driven. According to Tesla, this was the <a href="https://www.teslamotors.com/blog/tragic-loss">first fatality in 130 million miles</a> (210 million kilometres) of use of its autopilot software driving autonomously. </p>
<p>This would suggest that Tesla’s autonomy is about the level of a human driver. This is probably not good enough to be giving it control. Remember that humans are still having to take over when the driving gets more difficult. I would want autonomous cars to be much safer before we give them control. </p>
<h2>Safety review</h2>
<p>Regulatory authorities are waking up to these concerns. StaySafe, the joint standing committee of the NSW parliament focused on road safety, is in the middle of an inquiry into driverless vehicles and road safety.</p>
<p>We need to act swiftly to update the rules and the regulatory environment. For instance, none of the legislation introduced to permit driverless cars onto the roads of California, Nevada, South Australia and elsewhere require autonomous cars to be distinguishable from human-driven cars. </p>
<p><a href="http://thefutureofai.blogspot.com/2016/06/motherboard-ai-professor-proposes.html?q=Turing">In my testimony</a> to the StaySafe committee, I argued that we need to put special plates on such cars or even a magenta flashing light.</p>
<p>A friend who owns a Tesla told me of a situation they encountered recently where this was needed.</p>
<p>The driver of a car in a lane being merged expected his Tesla to speed up or slow down to create a suitable gap. But Tesla’s software is not programmed for courtesy. It continued to drive at a constant speed. My friend had to take back control to prevent a high speed collision. </p>
<p>When we started to build aeroplanes 100 years ago, anything went. But we quickly constructed a strong regulatory framework to ensure public safety. We need to build similar safeguards into the emerging industry for driverless cars.</p>
<p>Until this has happened, we need to question whether Tesla’s autopilot should be allowed on our roads.</p><img src="https://counter.theconversation.com/content/62495/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Toby Walsh does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Two Tesla cars running on autopilot have crashed this year, and one driver was killed. It raises the question of whether the company’s autonomous driving system is safe for our roads.Toby Walsh, Professor of AI at UNSW, Research Group Leader, Data61Licensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/474252015-09-15T20:17:16Z2015-09-15T20:17:16ZMore Mad Max than max safety: teenagers don’t dream of safe cars<figure><img src="https://images.theconversation.com/files/94755/original/image-20150915-16973-1ibafaw.png?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Weapons and flames: this 'dream car' design by teenagers doesn't include any safety features.</span> <span class="attribution"><span class="source">Bridie Scott-Parker</span>, <span class="license">Author provided</span></span></figcaption></figure><p>Hardly a week goes by without <a href="http://www.heraldsun.com.au/news/national/jandakot-car-crash-victims-family-urge-young-drivers-to-change/story-fnii5thm-1227520156323">calls for something to be done</a> to prevent any further deaths or serious injuries caused by young drivers on our roads.</p>
<p>We know that <a href="https://theconversation.com/a-new-approach-to-cut-death-toll-of-young-people-in-road-accidents-25372">young drivers are at greater risk</a> of being hurt or killed in a road crash, particularly when they have their P plate.</p>
<p>An important part of trying to keep them safe is to gain as much benefit as possible from the <a href="https://theconversation.com/what-parents-need-to-know-about-learner-drivers-four-key-lessons-30034">learner licence phase</a>. Another very important factor – and one often overlooked by eager young drivers and parents relieved at no longer accompanying their learner on every drive – is the car they drive.</p>
<p>Research consistently reveals that <a href="http://www.ncbi.nlm.nih.gov/pubmed/22133331">most P-platers</a> have access either to their own vehicle or the exclusive use of a family vehicle. P-platers in these situations report more risky driving behaviours such as speeding, not wearing seatbelts and showing off to friends.</p>
<p>When it comes to owning their own car, young drivers are more likely to drive <a href="http://www.sciencedirect.com/science/article/pii/S0022437515000559">smaller, older cars</a> with fewer crash-avoidance mechanisms, such as electronic stability control, and fewer crash-protection mechanisms, such as airbags.</p>
<p>Safer cars <a href="http://www.monash.edu.au/miri/research/reports/muarc292.html">improve</a> crash outcomes such as reducing death or injuries to drivers and others. But safer cars with crash-avoidance and crash-protection features are usually more expensive – not just to buy, but also to insure – meaning that they may be out of the reach of young drivers and/or their families. </p>
<p>Getting your own car is a very exciting part of being able to drive independently. Young drivers commonly form an opinion about what car they want long before they actually have a P-plate and the funds to buy and/or borrow the car from family members.</p>
<h2>Designing the ‘dream car’</h2>
<p>So what motivates their choice of a future car? I’ve analysed the features of 152 “dream cars” created by small groups of teenagers in Queensland and New South Wales. </p>
<p>We asked teens attending Year 11 in high school – many of whom are likely to have a learner licence already and be dreaming of their own car – to work together to design their dream car. Using this approach means that not only can we learn about what is most important but also we can gain some insight into peer pressure. Some designs were clearly drawn by groups made up of only boys, others by groups containing only girls, and the remaining groups containing a mix of boys and girls. </p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/94757/original/image-20150915-16968-lvore3.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/94757/original/image-20150915-16968-lvore3.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/94757/original/image-20150915-16968-lvore3.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=363&fit=crop&dpr=1 600w, https://images.theconversation.com/files/94757/original/image-20150915-16968-lvore3.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=363&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/94757/original/image-20150915-16968-lvore3.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=363&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/94757/original/image-20150915-16968-lvore3.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=456&fit=crop&dpr=1 754w, https://images.theconversation.com/files/94757/original/image-20150915-16968-lvore3.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=456&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/94757/original/image-20150915-16968-lvore3.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=456&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">No guns but wings this time. There was a difference in the ‘dream car’ designs of boys and girls.</span>
<span class="attribution"><span class="source">Bridie Scott-Parker</span>, <span class="license">Author provided</span></span>
</figcaption>
</figure>
<p>Here are the most common features.</p>
<p><strong>1. Standard vehicle features</strong></p>
<p>At least one standard vehicle feature, such as headlights, steering wheels, seat and seatbelts, was included on three-quarters of the designs. This is a good sign – we want young drivers in cars with seatbelts.</p>
<p><strong>2. Safety vehicle features</strong></p>
<p>One or more safety vehicle features, such as airbags and traction control, were noted on only one-third of designs. This is not a good sign – we want every young driver in a car with multiple safety features. Only two designs featured an anti-lock braking system (ABS), a vital safety feature which can prevent the young driver from crashing in the first place.</p>
<p><strong>3. Luxury vehicle features</strong></p>
<p>Four out of five designs mentioned luxury features such as fancy rims and paint, car body attachments and extra lights (in addition to headlights, brake lights, hazard lights/indicators). This tells us that young drivers are highly focused on how their car looks, and not necessarily on whether the car will keep them out of a crash or protect them if they do crash.</p>
<p><strong>4. Bizarre vehicle features</strong></p>
<p>There is no other way than “bizarre” to categorise features such as guns and armoury, spikes, wings and a selfie booth. Guns and/or armoury featured on nearly one in seven designs, and spikes on tyres and/or the vehicle body featured on ten designs. Such things certainly won’t help keep them out of that crash, or protect them if they do crash.</p>
<p><strong>5. Other vehicle features</strong></p>
<p>One in eight designs had features such as a roof rack, a pocket for their phone, or a bike rack. </p>
<p>So what do these five observations imply? It means that we need to better educate young people about safety before they get their P-plates and are buying or driving their “dream car”. We need to educate them about the importance of driving as safe a car as possible, rather than dreaming about mag wheels and psychedelic paint. Instead, we need them to dream about traction control and curtain airbags, reversing and blind-spot cameras.</p>
<h2>The parents can help</h2>
<p>Parents also play a pivotal role in the car that young people ultimately drive. Perplexingly, however, <a href="http://www.ncbi.nlm.nih.gov/pubmed/18054603">research</a> has revealed that while parents are concerned about their child’s safety, they often intend to buy them a smaller, older car or a car with reduced crashworthiness.</p>
<p>Many parents don’t know the safety features they should seek in a car for themselves, let alone their young driver, and they don’t know how safety features such as ABS actually work. </p>
<p>This tells us we need to get parents and their teenagers on the same page before they even begin to drive. Parents and young drivers could investigate the safety of the family car, with a multitude of websites summarising the crashworthiness of <a href="http://www.howsafeisyourcar.com.au/">new</a> and <a href="http://www.racq.com.au/cars-and-driving/cars/buying-a-car">used</a> cars.</p>
<p>Parents and their teenagers could work together to investigate exactly how these safety features prevent a crash and/or protect in the event of a crash.</p>
<p>We know P-platers are more likely to crash now than in any other stage of their driving lifetime. So doesn’t it make sense that one simple step to help keep them safe is to make sure they drive the safest car possible?</p>
<p>We need to start a conversation around how we make this happen. Education alone is insufficient, but it is a vital part in a much larger plan.</p>
<hr>
<p><em>Bridie Scott-Parker will be on hand for an Author Q&A between 11am and noon AEST on Wednesday, September 16, 2015. Post your questions in the comments section below.</em></p><img src="https://counter.theconversation.com/content/47425/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Bridie Scott-Parker receives funding from the National Health and Medical Research Council via a Research Fellowship. </span></em></p>Teenagers are more interested in gadgets and flashy desig in their first car than they are about safety features. So how do we make them think safety is important?Bridie Scott-Parker, Research Fellow, University of the Sunshine CoastLicensed as Creative Commons – attribution, no derivatives.