Safer Streets in Viet Nam: A Public Health Turnaround?

When I made my first visit to Viet Nam last month, to visit Atlantic’s office and staff there and travel to rural health clinics, hospitals, schools and NGOs that we support, I couldn’t help but notice that the streets of Ha Noi were teeming with vehicles, mostly motorbikes, often with multiple riders and carrying all manner of cargo, including animals. The scene made New York City traffic seem like rural Iowa by comparison.

Viet Nam has experienced marked economic growth, urbanisation and changes in technology in the past dozen years or so, and while that is in large part a good thing, there are unfortunate side effects as well. One of those is a sharp increase in motor vehicle injuries. Just among our seven-person staff in Ha Noi, four have been in traffic accidents in the last year.

Since 1994, the number of automobiles in Viet Nam increased two-and-a-half times and the number of motorbikes increased eight-and-a-half times. The increased traffic volume inevitably led to higher numbers of traffic-related injuries. In 2006 alone, deaths and injuries resulting from traffic accidents were about 13,000 cases and 37,000 cases, respectively.

In addition, there is a growing consensus in public health community in Viet Nam that injury is a leading cause of deaths and disability for children and youths under 17 years old. Despite large gaps in reporting, it appears that everyday around 35 children drown and 11 children die on roads, while another 4,300 children are injured as a result of falling, burning and poisoning.

The good news is that this kind of public health problem is particularly susceptible to education and prevention. The harms from traffic injuries and children’s accidents can be sharply reduced through a combination of safety training and, where necessary, mandatory measures – think of seat belt laws in the United States – that alter the culture in which injuries and deaths from accidents flourish.

“Many of the traffic injuries and deaths result from preventable head traumas,” notes Atlantic Viet Nam programme executive Dr. Duong Hoang Quyen. “Data from a hospital in Ho Chi Minh City shows that 85 percent of its traffic-related patients were motorcyclists, and that nearly 74 percent of its traffic-related hospitalization cases in 2006 were due to head injuries. It goes without saying that these figures could be improved dramatically if more people used helmets.”

Since 2000, the government has responded to the injury epidemic with a number of major structural interventions, including the adoption of a national policy and legal framework buttressed by the establishment of national coordinating bodies on injury prevention and control.

Atlantic has joined other donors in playing a pivotal role in assisting the government of Viet Nam to tackle the injury problem. We’ve been involved with injury prevention in Viet Nam since 2000, attempting to support the country in its efforts to acquire the capacity to prevent the deaths and disabilities associated with injuries. To date, Atlantic awarded over $17 million to 16 projects of private foundations, multilateral organization, academic institutions, international non-governmental organizations, and the Government.

These projects enabled a well-known multilateral organization, UNICEF, to bring childhood injury prevention into its day-to-day programming and to reach an agreement with the Government in rolling out the program, and also contributed to the establishment and growth of the Asia Injury Prevention Foundation to promote traffic safety and change attitudes about helmet use through creation of innovative public awareness campaigns for kids. They also strengthened capacity of the Ha Noi School of Public Health in teaching and carrying out research related to injuries and its risk factors and consequences.

Building on these accomplishments, and working in partnership with a government determined to reduce unnecessary deaths and injuries, the priority areas for Atlantic in the next five years include scaling up community-based childhood injury prevention programmes through a combination of legislative reinforcement and evidence-based demonstrations; strengthening the emergency medical services through the development and introduction of a comprehensive model in pre-hospital trauma care; building the capacity of young Vietnamese public health researchers; and enhancing national leadership and coordination by focusing actions on achieving visible deliverables with clear results.

I was impressed by the early signs of progress that Viet Nam is making in bringing down the numbers of avoidable injuries and deaths through sensible public health policies. But on the day I got back from my trip I opened the New York Times to find a story about a sharp spike in motorcycle injuries in the United States. Here, motorcycles make up about less than 1% of all vehicles on the road but account for over 10% of highway deaths. The problem is getting worse, because unlike Viet Nam, the U.S. is moving in the wrong direction on this issue. Thanks to an aggressive lobbying campaign by misguided libertarian motorbike enthusiasts, state after state– 27 since 1975– has repealed its mandatory helmet law, with predictable and bloody results. Motorcycle deaths have risen 100 percent in the last ten years.

Wearing an approved helmet cuts the risk of death in an accident by 37%. You’d think a mandatory helmet policy would be, if you will forgive the terrible pun, a no-brainer. This is something Viet Nam is starting to get right, and Atlantic is proud to be able to help.

Gara LaMarche