Devastating Deaths: The Contribution of Road Deaths to Crime, Injuries, and Violence
The National Injury Mortality Surveillance System (NIMSS) is managed and maintained by the Crime, Violence, and Injury (CVI) Major Program, which, in turn, is co-directed by the Medical Research Council and the Social Sciences Institute and UNISA Health.
This research program was initiated to provide information that, after 1991, was no longer collected as national statistics. Data for 2003 (the latest year available) were collected from seven provinces in South Africa. Only a percentage of morgues fill out the forms voluntarily, but each year more join the program and the sample size is improving.
The ultimate goal of NIMSS is to link its system to birth and death registries, the police database, and the national highway crash and injury database. These crime, injury, and violent death statistics are compiled from existing investigative procedures at morgues, state forensic laboratories, and the courts.
“Accessibility to knowledge that cuts across traditional rubrics between government academia and the private sector presents new possibilities for a science-backed knowledge-driven service that is available to the public and private health sectors in South Africa.”
The Arrive Alive database collects traffic accident information from police reports of car accidents, which means that only ‘on-the-spot’ or immediate deaths are recorded as such. Injuries sustained in motor vehicle accidents, but which later result in death, are therefore not recorded as fatalities in the Arrive Alive system.
The CVI information captured relates to the “who, what, when, where and how of all fatal injuries” (Fifth Annual Report 2003). If complete, it would be more conclusive than the Arrive Alive database, though less immediate.
looking at the glass
One of South Africa’s biggest problems is that its statistics were not kept up to date during the last decade of the 20th century. As a result, planning for the future has sometimes been based more on assumptions than scientific fact; a great handicap for those tasked with making decisions.
“Major policy decisions today tend to be informed by limited data, biased media reporting, and political considerations.”
NIMSS annual reports can be of great help to national, provincial, and municipal researchers and planners. They provide a basis on which important development strategies must be coordinated. They are extremely relevant to crime, health and transportation services. While senior officials may receive copies of the reports, officials working to improve their qualifications are unlikely to be aware of their existence.
While each death causes significant personal trauma to the friends and family of the deceased and where the lives of breadwinners, parents and children are lost, in addition to considerable personal financial hardship, it is the state that bears the significant burden. , collective, social and economic.
“The effective allocation of resources to treat and prevent injuries can only be optimized through coordinated national, provincial, and municipal or regional programs.”
Unless the state is sufficiently informed, how can resources be properly distributed to adequately deal with the status quo? Social welfare, social subsidies, as well as emergency and trauma services are just some of the issues directly affected by the number and type of deaths in the country. Less obviously, the land needed for use as cemeteries, the number of designated police/traffic officers, etc. also becomes part of the equation.
The CVI reports cover all types of violent and unnatural deaths, including the categories of “violence, suicide, death in transportation, death from unintentional injury, and undetermined death” (Fifth Annual Report 2003). Including undetermined deaths, 22,248 unnatural deaths were examined since 2003, of which 81% were men and 19% women. Figure 1 illustrates the main different causes of death by number and percentage:
Table 1: Main external causes of death (N = 22,248)
Cause of death Number of deaths Percentage of deaths
Firearms 6 167 27.7
Shear force injury 3 276 14.7
Pedestrian 2 642 11.9
Blunt force injury 1,565 7.0
Unspecified motor vehicle 1,400 6.3
Burns 1,175 5.3
Hanged 1,083 4.9
Motor vehicle passenger 1,028 4.7
Motor vehicle driver 1,023 4.6
Drowning 406 1.8
Various other causes 2 317 10.4
Unknown causes 166 0.7
Total 22,248,100.0
Source: Fifth Annual Report 2003 of the National Mortality Surveillance System due to Injuries
Therefore, we can state in Table 1 that when traffic accidents involving pedestrians (11.9%), unspecified motor vehicles (6.3%), passengers (4.7%) and drivers ( 4.6%), represent practically the same amount (27.5%) unnatural deaths as firearms. Certainly enough for health authorities around the world to consider it a national crisis?
Most people reading this will be aware of the higher than average cost of road injuries in the system. Seriously injured victims often require more emergency help, more complicated surgeries, and more dedicated nursing, for long periods of time. Thereafter, rehabilitation and wellness services must be put in place, even before the traffic accident claim has been finalized.
For every female death, there were 4.4 male deaths. Among men, pedestrian fatalities (11%) were the third most common cause of death. Among women, pedestrian fatalities led the way, at 16%. Passenger deaths ranked fourth on the list for female deaths, at 10%.
“Prevention must be integrated into social and educational policies, thus promoting social and gender equity.”
39% of transportation-related deaths were related to pedestrians, followed by unspecified deaths (20.9%), passenger deaths (15.4%) and drivers (15.3%). The balance included deaths related to rail and aviation.
“Of the 6,689 transportation-related deaths, pedestrians accounted for 40%, passengers 15%, and drivers 15%. 5% of transportation-related deaths were rail-related. In regards to level crossings, these may involve a combination of rail and road use. Another 21% of transport-related fatalities were due to motor vehicle collisions, but the category of road user was unknown.”
It would be extremely interesting to know the reasons why some deaths are not specified. When asked, one of the researchers from the CVI program questioned that the information funeral homes receive from hospitals and then pass on is often woefully insufficient. Where the exact cause may have been known on arrival at the hospital, the information is sometimes not passed on to the morgue.
Transportation-related deaths accounted for 30% of the total, while violence accounted for 48% of the total. Transportation-related injuries were the leading cause of death in the 0-14 age group (28%), but passenger deaths in the same group, at 8%, were less common than drowning deaths and burns. Transportation-related injuries in the 55+ age group were also the leading cause of unnatural death.
Whatever the group of road users (pedestrian, driver or passenger), fatalities were highest in the 30-34 age group. The 35-39 age group was the next highest, for pedestrians and drivers, but passengers aged 25-29 proved to be at higher risk than passengers in the 35-39 category.
“Information about the prevalence, magnitude, patterns, causes and consequences of injuries has value if used effectively to prevent injuries and save lives.”
The city-level data in the report is more comprehensive than that for rural areas and revealed that, of the four cities (Tshwane, Johannesburg, Cape Town and Durban) examined extensively:
“Johannesburg had the highest transportation fatality rate (37/100,000 population) as well as the highest traffic fatality rate (36/100,000 population).”
The majority of male fatalities, as can be seen in Figure 2, were pedestrian fatalities (39%), followed by unspecified motor vehicle fatalities (21%), motor vehicle driver fatalities (18%), and passenger fatalities (12%).
“However, information is only a single component in progress toward safer, injury-free cities…such information can, and indeed should, be translated into the creation of concrete injury prevention policies and practices.”
Blood alcohol concentration was positive for 61% of pedestrians and 58% of drivers. People who are hospitalized after an accident and do not succumb to death for several days are unlikely to show an alcohol concentration above the limit at the time of their death, so these figures might be conservative.
Table 2: Blood alcohol levels (g/100 ml) by external cause of deaths in road transport (N = 6,319)
External cause Number BAC analysis N (%) BAC-positive N (%) Mean BAC Std dev.
Pedestrian 2,639 1,412 (53.5) 858 (60.8) 0.22 0.10
Passenger 1,028 368 (35.8) 152 (41.3) 0.14 0.10
Driver 1,021 562 (55.0) 327 (58.2) 0.18 0.09
Unspecified 1400 405 (28.9) 196 (48.4) 0.19 0.10
Cyclist 231 125 (54.1) 50 (40.0) 0.14 0.10
Total 6,319 2,872 1,583 0.17 0.01
Source: Fifth Annual Report 2003 of the National Mortality Surveillance System due to Injuries
“A systemic review of the violence and injury sector in South Africa should be undertaken along the lines of the two World Health Organization World Reports on Violence (2002) and Road Traffic Injuries (2004). The proposed revision may also serve to highlight gaps between data and action.”
The information in this article represents only part of the information presented in the annual report, and an even smaller portion of that collected but not included in the annual report.
It does not reflect useful information, such as suburban data or “black spot” data, that may reside in the surveillance database. This would greatly enhance the understanding needed to run, for example, the Arrive Alive program and prevention agencies are encouraged to contact the CVI program for custom reporting and data analysis.