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Bulletin of the World Health Organization

Print version ISSN 0042-9686

Bull World Health Organ vol.87 n.8 Genebra Aug. 2009 



Buckling up is "cool" on Russian island



More people are buckling up when they get in a car on the far eastern island of Sakhalin than anywhere else in the Russian Federation, according to a local partnership that ran a four-year public awareness campaign backed by strict enforcement of national seat belt laws. Dmitry Zelinsky reports.

It happened on a clear September day in 2004. Elena Vorontsova-Kasumyan, an employee of Sakhalin Energy, was travelling from a remote onshore oil processing facility on Sakhalin. She sat next to the driver, who asked his passengers in the utility vehicle to buckle up. Everyone did, except the woman seated behind her. An hour into the journey, the vehicle plunged into a metre-deep washout. Only one person died from her injuries: the woman without the seat belt.

Nine months later, the company joined forces with Sakhalin's local government, traffic police, nongovernmental organizations and other businesses to develop the Sakhalin Road Safety Partnership. The 2004 fatal crash was the trigger for the initiative, but it followed a steep increase in crashes on Sakhalin's roads in previous years.

"The safety of our workers is one of our priorities," says Johan Peters, Sakhalin Energy's health, safety and environment manager. "One of the main risks for us is road safety." To reduce this risk, the company provides road safety training for staff and participates in the Sakhalin Road Safety Partnership.



Thousands of people came to Sakhalin to work in the energy sector after the 1995 discovery of oil and natural gas off the eastern coast of the Russian Federation. And while the island's economy boomed, its streets filled with cars. Between 2001 and 2004 alone, road crashes on the island increased by 38.2%, while the number of people killed as a result of road crashes increased by 13% on the island with its 580 000 population, according to Sakhalin police data.

The fatal crash in September 2004 acted as a trigger for an important part of the Sakhalin Road Safety Partnership's work: a seat-belt campaign. "The campaign was based on global good practice, incorporating all the awareness and enforcement elements recognized internationally as being needed to reach a good result," says Andrew Pearce, chief executive of the Global Road Safety Partnership, which supported the establishment of the Sakhalin partnership and which is hosted by the International Federation of the Red Cross and Red Crescent Societies in Geneva.

Sakhalin Energy took the issue so seriously that it established its own road traffic safety department. Evgenia Rodina, team leader in that department, remembers the challenge they faced. "There was very little public awareness that wearing seat belts saves lives." And it wasn't only lack of awareness. Unhelpful urban myths also circulated. Some people claimed it was dangerous to wear a seat belt; that they prevented people from getting out of the car in the event of a crash.



To find out how bad the problem was, the Sakhalin Road Safety Partnership asked the local traffic police, but was unable to obtain precise figures on the number of cases of non-compliance because, as Yury Zhdanov, deputy director of the State Traffic Safety Inspectorate in the Sakhalin region explains, the police categorized seat-belt infractions as "other offences".

Working closely with the traffic police, the Sakhalin partnership launched the Choose Life - Buckle Up campaign, which made extensive use of television and radio advertisements, and got its message out into the streets across the island with billboards and banners.

To evaluate the four-year seat belt campaign from 2005 to 2008, they carried out surveys in the summer months when police data showed an increase in crashes. At selected traffic lights across the island, small teams from the Partnership did surveys in June and October, to record the number of drivers and passengers wearing seat belts before and after their interventions.

This was backed by video cameras. "We wanted to see how many people wore belts in reality," Rodina says. The reality was shocking. At the outset, only 2-3% of the local population buckled up. Three years into the campaign, in January 2008, the Russian Federation government tightened existing seat-belt legislation by increasing fines tenfold from 50 roubles (US$ 1.56 on 15 July 2009) to 500 roubles.

The Sakhalin partnership also carried out opinion surveys to track awareness and they discovered that television, radio, cinema and billboards were effective tools in communicating their messages. The seat-belt campaign received widespread support, and, according to Rodina, there was so much interest that newspapers published articles about it, and provided it with free advertising space. Inspectors from the State Traffic Safety Inspectorate made a crucial contribution to the campaign, by undergoing professional development and stepping up enforcement of seat-belt law. Still, Zhdanov points to funding constraints that in his view held the campaign back, but he is among the first to acknowledge its positive impact.

It's hard not to. According to the Sakhalin partnership's evaluation of its four-year campaign, which has not been published, seat-belt use increased from around 3% to 80% on the island, as compared with national average compliance rates of 33% for the whole of the Russian Federation, according to 2007 data from the Road Safety Department of the Ministry of Internal Affairs. Further studies would be needed for a full scientific evaluation of the campaign, but neither Rodina nor Zhdanov are in any doubt that it was a success.



"We started out by spreading the word for a period of two weeks," says Zhdanov. "Then road users were given warnings. After that they were fined. When this kind of leverage is used, positive results are guaranteed. Public relations alone are not enough," he says. Having started out by targeting all drivers and passengers in cars, the campaign has recently switched gear and is now targeting the most seat-belt resistant group - young men aged between 18 and 35 years old - with poster slogans, such as "It's cool to be alive. Buckle up."

Any credit for reductions in road traffic injuries and deaths must be shared with a whole host of road safety initiatives undertaken by the regional administration and the traffic police. Other improvements included: reflective traffic signs, clearer road markings and speed bumps in places where crashes were known to have occurred.

Further significant initiatives of the Sakhalin Road Safety Partnership include the 2006 launch of a technical assistance project to train paramedics to respond to crashes and the Safe Routes to Schools project.



"The Sakhalin seat-belt campaign provides a number of good lessons," says Dr Meleckidzedeck Khayesi from the Unintentional Injuries Prevention unit at the World Health Organization. "It shows how personal experience led to the initiation of an intervention that combined awareness raising with enforcement, while undertaking other measures at the same time."

Five years after the crash, Vorontsova-Kasumyan still finds it hard to believe what happened after the four-wheel drive vehicle plunged into the ditch. "I never thought that a person could go through the seat of a special utility vehicle," she says, "but that was exactly what happened."

The woman without the seat belt was seriously injured, with a broken pelvis, several broken ribs and other injuries. Although she was rapidly airlifted to hospital, she died five weeks later of her injuries. A significant factor in her death was the poor quality post-crash care she received.

Vorontsova-Kasumyan was saved by her seat belt. The injuries she did sustain, including broken ribs, damage to her spine, severe concussion and the loss of hearing in her left ear, were for the most part caused by the woman who slammed into her from behind. These days, given the level of seat-belt use on Sakhalin, such injuries are less likely to occur, but Vorontsova-Kasumyan would like to eliminate them all. "It is important not only to advocate for change, but also to impose legal authority so that putting on a safety belt is automatic; so that people feel undressed if they are not wearing a seat belt."