1. 1 Road traffic injury risk in a regional public health perspective Stig H. Jorgensen Department of Geography, Norwegian University of Science and Technology (NTNU) NO-7491 Trondheim, Norway Paper for The Society for Risk Analysis – Europe conference: Innovation and Technical Progress: Benefit without Risk? Ljubljana 11 – 13 September, 2006

2. Overview 1.Discuss effects of a massive strategy for road safety and risk minimizing (Vision Zero) 2.Present geographical and structural trends for private motor vehicle crashes, Norway 1998 – 2004. 3.The scopes for following up strategies on road safety and health promotion in a regional perspective 4.Conclusions.

3. The Vision Zero strategy Carried out year 2000. Focus: seriously injured and killed road users. (Zero fatal traffic injuries year 2030?) A system risk perspective: the interplay of road users and vehicles in the road system. A contract between: road authorities (system designers) and individuals (road users).

4. Background: road safety and public health A new paradigm (and demand?) for road traffic in public health. Basic principles founded in ethics and equity. (cf. ’innocent’ victims in crashes, the value of a life lost in traffic) Unnecessary and avoidable health risks (?) Public health trade off for other (transport) benefits. (accessibility, regional competition and attractiveness) Smoothing out structural (system) inequalities in public health risk. (pollution; food and water quality etc.) System functions versus individual responsibility and risk taking.

5. Implications of risk minimization Unrealistic (system risk, human unfallibility) Individualism (freedom, coping capacity) vs standardisation The possibility for injuring other (’innocent’) road users Risk minimization versus risk optimization ” Zero risk” urges perfectionism ”Healthism”, tolerance for deviation Territorial justice is difficult to achieve

6. Possibilities for implementing efficient safety measures Physical environment, land use and transportation modes Road network investments Traffic calming schemes Enforcement and controls (depriving of freedom) Police enforcement, speed cameras Drivers attitudes and risk-taking behaviour Education, training, campaigns Public consciousness, publicity Diffusion of safety behavioural changes (safety culture) Vehicle safety devices and technology Alcohol interlocks, Intelligent speed limiters

7. Safety priorities favouring urbanised areas ? Intended effects: The per capita principle and road safety investments Concentrated in areas with the highest absolute no. of fatalities Supported by cost-effectiveness/cost-benefit assessments Preferences for population strategies towards low-risk groups Non-intended effects: Concentrated efforts in high traffic volume areas:  a systematic geographical difference in the relative risk level. A redistribution, with a higher risk level in the rural areas ? More risk prone rural population?

8. Traffic accident data Police-recorded road traffic accidents 1998-2004. (Norwegian Public Roads Administration) Selection: motorized road users, private 4-wheel automobiles: killed and seriously injured (N= 5233) Population based approach: the casualty’s place of residence - Degree of coverage for residential municipality (1999-2004) - for the whole country: 84.8 % (N = 4247 out of 5008) Specific missing percentages for: adequate protection: 39% alcohol suspicion: 1% Possible systematic bias: underreporting in rural municipalities

9. Grouping of municipalities into area types Classification by: Population density (percentages in densely populated areas) Size of settlement ( 15 000) Type of place No of municipalities Total population 2000 No and percentages of casualties (place of residence) 1999-2004 Rural 3301 330 000 1 709 ( 40.3 %) Peri-urban 66 924 000 994 ( 23.4 %) Urban 362 218 000 1 537 ( 36.3 %) NORWAY 4424 472 000 4 247 (100.0 %)

10. Fig. 1 Map of Norwegian municipalities displayed by an rural-urban gradient 1998 - 2004

11. Fig. 2 Number of killed and seriously injured people, in private 4-wheel motor vehicles, by sparsely/densely populated area and type of place of accident. Norway 1999 – 2004.

12. Fig. 3 Percentage of killed and seriously injured people, in private 4-wheel motor vehicles, by sparsely/densely populated area and type of place of accident. Norway 1998 – 2004.

13. Fig. 4 Killed and seriously injured people, in private 4-wheel motor vehicles. Rate per 100, 000 population (sex and age adjusted) by sparsely/densely populated area and type of place of residence. Norway 2004 (N rural = 299) (N periurban = 171) (N urban = 234)

14. Fig. 5 Percentage of killed and seriously injured people, in private 4-wheel motor vehicles, by type of place of residence. Norway 1999 – 2004. (N 6 years = 1709) (N 6 years = 994) (N 6 years = 1537)

15. Fig. 6 Percentage killed and seriously injured people not using seatbelts, in private 4-wheel motor vehicles by type of place of residence. Norway 1998 - 2004. (N 7 years = 352) (N 7 years = 167) (N 7 years = 158)

16. Fig. 7 Percentage killed and seriously injured people with suspicion of alcohol alcohol in private 4-wheel motor vehicles by type of place of residence. Norway 1998 - 2004. (N 6 years = 292) (N 6 years = 128) (N 6 years = 255)

17. Fig. 8 Percentage killed and seriously injured males involved in risk taking driving (non-usage of seatbelt or alcohol or running off the road) 4-wheel motor vehicles by age and type of place of residence. Norway 1999-2004.

18. Table 3. Road traffic injury rates (for 7 years), killed and serious injured 4 wheel motorised road users per 1000 population, by type of residential municipality (education). Norway 1998-2004.

19. Goal and intrests conflicts The traffic system vs. the health system Local health safety versus to consolidate settlements Market failures and negative external effects in the road transport system Health risks are often considered as long time accummulated risks (smoking, diet habits)

20. Geographical redistribution of risk Structural inequality (in specific geographical environments) Non-intended results of efficiency and accessability Territotial equity and uneven development in health policy Neo-liberalism winds (favouring market competition solutions, and distributions) Compensation mechanisms ?

21. Strategies 1.”Standardisation” of human (driving) activities 2. Technical control of risk minimizing behaviour 3. Widespread surveillance and control system

22. Risk minimising strategies Balancing urban-rural efficiency, equality and equity Compensation, positive discrimination in road improvements Implementation of non-human control systems Tailor made behavioural campaigns (local engagement)

23. Conclusions Killed and seriously injured automobile occupants are concentrated in sparsely populated areas. Disparities urban - rural areas are not increasing over time. Effects of “Vision Zero” regarding road users place of residence: Rural people face a higher serious accident rate. A geographical redistribution of crash risk in disfavour of sparsely populated areas, not in disfavour of rural areas in general. No tendencies to absolute reductions or redistribution of casualties related to driving violation

24. A public health goal of risk minimization seems less feasible in rural and sparsely populated areas for various geographical and structural reasons. Stronger, and more controversal, countermeasures have to be implemented in rural areas The effects have to be monitored for a longer time span.