Fall 2004 archive of past newsletters

DEVELOPING AN EFFECTIVE AND APPROPRIATE HELMET FOR THE TROPICS: PROTECTING THE VULNERABLE ROAD USER

In low-income countries, users of bicycle and motorbikes, rather than occupants of automobiles, are most often the victims of traffic injuries. These victims, often termed vulnerable road users, frequently die or suffer permanent brain injury as a result of crashes on bicycles and motorbikes. With improved roadways and growing economies, the number of motorbikes in low-income countries (LIC) is increasing at a dramatic rate. Not surprisingly, the number of head injuries due to crashes is increasing as well. In Vietnam, for example, the number of motorbikes grew from 500,000 to 10,000,000 in the past ten years, and head injuries and deaths of unhelmeted motorbike riders increased proportionally.

Helmets protect the motorbike rider
Studies in high income countries have shown that wearing a properly designed bicycle or motorcycle helmet reduces the risk of head injury in a crash by 20-45 percent¹. Most helmets have been designed for use in temperate climates and on roadways with vastly different traffic patterns. In LIC, motorcycle helmets are infrequently worn by riders because they are felt to be hot, uncomfortable, expensive and not useful in preventing head injury^2,3. Many helmets made locally in LIC are poorly constructed and offer little or no effective protection. To be effective in tropical countries, helmets used must be comfortable, affordable and provide protection in the traffic patterns seen in LIC.

One of the grand challenges in global health is designing a motorbike helmet for use in low-income countries. An effective helmet design, suitable for local manufacture, distribution, sale and promotion, could lead to a reduction of fatalities and brain injuries among motorbike riders by 20-50%.

Why propose this challenge now?
Most traffic safety efforts to date, however, have focused on policy and strategy planning using Western, rather than LIC, patterns of road safety, standards and programs. Little consideration is given to the safety of people who are not the occupants of motor vehicles. This is partly because public health, transport, and safety specialists lack specific knowledge about crash conditions and injuries that occur to the vulnerable road user. Information specific to low-income countries is needed on the characteristics of crashes and traffic patterns, the types of injuries, the biomechanical forces and the social, anthropological, and economic patterns of helmet use. These data will define the design parameters for a helmet that is inexpensive, comfortable, cool, lightweight, culturally acceptable, and effective in reducing head and brain injuries from motorbike crashes in LIC.

Scientific and technical advances are needed to meet this challenge
Defining the epidemiological, biomedical, and crash parameters of vulnerable road user injuries will lead to the development of an effective helmet for use in LIC. This helmet, conforming to the crash, cultural, and environmental conditions of LIC can be manufactured locally by private or private/public ventures. We anticipate that a helmet – designed specifically for use in LIC – will be locally developed and manufactured.

These advances are possible and change is feasible
The growing numbers of fatalities and injuries in the developing world are reaching a critical level - a “tipping point” - where traffic injuries’ impact on the individual, society, and economies are now so great that they must be addressed. Knowledge of the crash, injury, and economic characteristics for the vulnerable road user will provide the scientific basis for the development of specific injury prevention strategies, including, but not limited to, design of tropical helmets. Once these strategies are developed, there is a great likelihood that the private sector will embrace these safety technologies, produce and promote specific products that reduce injuries. By creating a scientific basis for the development of effective road safety interventions, the opportunity for private as well as public support for the implementation of these new measures will be increased.

Multisectoral collaboration needed
There are exciting opportunities for multisectoral collaboration between LIC and Western countries in the development of a tropical helmet. Engineering, technology, and public health institutes in LIC and HIC will play important roles. Since much of the development of these parameters will involve case investigation and forensic study there is a great likelihood that much of the field work will be conducted by LIC, while modeling and actual testing is likely to occur in Western institutions.

REFERENCES
1. Sosin, D., J. Sacks, and P. Holmgren, Head injury-associated deaths from motorcycle crashes. JAMA, 1990. 264: p. 2395-2399.
2. Mohan, D., Road safety in less-motorized environments: future concerns. Intl Journal Epidemiology, 2002. 31: p. 527-532.
3. Conrad, P., et al., Helmets, injuries and cultural definitions: motorcycle injury in urban Indonesia. Accident Analysis & Prevention., 1996. 28(2): p. 193-200.

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