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Helmet wearing legislation (Vietnam)
Head injury is the most common contributor to fatality and serious injury in road crashes. Motorcycle riders are particularly vulnerable to head injury, but in many jurisdictions people are reluctant to wear helmets and enforcement is not a high priority.
Vietnam has one of the highest proportions of PTWs in its traffic (around 90%) and in the 1990s had very low helmet wearing rates. Now, wearing rates of 90% or more are reported following the introduction of mandatory helmet use legislation in 2007 (Passmore et al, 2010a). This has been associated with an apparent reduction in head injury among injured motorcyclists (Passmore et al, 2010b). This is a remarkable achievement, but it was not achieved by a single piece of legislation; instead a number of incremental changes were made over a period of time: to helmet standards, penalties, the helmet market, and attitudes to wearing.
The problem of helmet wearing in Vietnam was initially addressed through cooperation between the Vietnamese Government, the Asia Injury Prevention Foundation and international agencies (including UNICEF). Market research demonstrated that resistance to helmet wearing was based partly on the nature of the helmet — those that met the existing standard were called "rice cookers" because they were hot and heavy, as well as being relatively expensive. In addition, a substantial proportion of passengers on motorcycles were children, for whom standard helmets are not appropriate.
A new standard was developed for the tropical helmet, which is lighter than a standard helmet and has more ventilation, and still provides a high level of protection in the kinds of crashes common in Vietnam (King, 2005). Extensive anthropometric work was undertaken to measure the size and shape of the heads of Vietnamese adults and children, since standard helmets are designed mainly for longer, narrower European heads. In addition to the revised adult standard, the world's first standard for a children's helmet was introduced, and a factory was built to produce tropical helmets at an affordable price. This is a non-profit business where any surpluses are spent on other safety programs, and one of its initiatives was to promote the helmets through the free distribution of thousands of helmets to high school students (who are both motorcycle riders and passengers). In addition, the government worked with the helmet industry to promote helmets that met the standards, via both advertising by manufacturers and the marketing practices of distributors.
On the legislative side, the resistance of Vietnamese motorcyclists to helmet wearing was addressed gradually. As the table (from Passmore et al, 2010a) shows, mandatory use was prescribed in 1995 by a government decree, but no penalty was imposed. From 2000 helmet wearing became compulsory on some national highways, and in 2001 a modest fine was introduced, although it was so low that there was little motivation to enforce it (King, 2005).
It is worth noting that the legislative instruments mentioned in the table are of different kinds and come from different levels of government. Research conducted around this time indicates that Vietnamese motorcyclists are sensitive to these differences, and less likely to heed decrees or circulars that do not emanate from the highest level (King, 2005). Observations of helmet wearing in 2001 and 2002 showed modest levels of wearing on a national highway and low levels elsewhere, dropping close to zero at night (King, 2005).
Over subsequent years, up to 2007, a strategy with several elements was pursued. Tropical helmets were widely marketed, a television advertising campaign using notable Vietnamese was undertaken, and there was a gradual increase in penalties and enforcement. These changes created conditions under which, in 2007, a law at the highest level could be passed, and fines could be significantly increased. By this time helmet ownership had reached about 90% (Hung et al, 2008; Pham et al, 2008), removing one of the barriers to helmet wearing. As a consequence, when the 2007 law was introduced, helmet wearing increased to very high levels. However it was observed that many riders did not fasten helmets properly, and this has been addressed by subsequent legislation.
This case study shows that changes in helmet wearing may require a lot more than just a legislative change, and that change might best be achieved incrementally, by working towards a good solution over a long period. It also demonstrates the value of collaboration between government, the private sector and non-government organisations.
References
Hung, D.V., Stevenson, M.R. and Ivers, R.Q. (2008). Barriers to, and factors associated, with observed motorcycle helmet use in Vietnam. Accident Analysis and Prevention, 40:1627-1633.
King, M.J. (2005). Case studies of the transfer of road safety knowledge and expertise from Western countries to Thailand and Vietnam, using an ecological 'road safety space' model: Elephants in traffic and rice cooker helmets. Unpublished PhD thesis. Brisbane, Australia: Queensland University of Technology, Centre for Accident Research and Road Safety — Queensland, 2005.
Pham, K.H., Thi, Q.X.L., Petrie, D.J., Adams, J. and Doran, C.M. (2008). Households' willingness to pay for a motorcycle helmet in Hanoi, Vietnam. Applied Health Economics and Health Policy, 6(2-3):137-144.
Passmore, J.W., Nguyen, L.H., Nguyen, N.P. and Olive, J.M. (2010a). The formulation and implementation of a national helmet law: a case study from Viet Nam. Bulletin of the World Health Organization, 88:783-787.
Passmore, J.W., Nguyen, T.H.T., Luong, M.A., Nguyen, D.C. and Nam, N.P. (2010b). Impact of mandatory motorcycle helmet wearing legislation on head injuries in Viet Nam: results of a preliminary analysis. Traffic Injury Prevention, 11(2):202-206.
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