Helmet Day

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LESSONS LEARNEDON VIETNAMSROAD TO HEALTHYBEHAVIOR


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The Social Science Research Council (SSRC) leads innovation, builds

interdisciplinary and international networks, and ocuses research on

important public issues. We bring necessary knowledge to public action.

SSRC Strategic Learning & Evaluation Research Team:

Mary Byrne McDonnellPrincipal Investigator

Van Bich Thi TranProject Coordinator

Nina R. McCoyVietnam Representative

May 2010

This work may be reely republished, redistributed, and used by others, provided that (i) it isor non-commercial purposes, (ii) the content o the work is not altered, and (iii) SSRC and theauthor(s) are properly credited as the source o the published work.

Cover photo: Jackie Williams Kaye, Strategic Learning and Evaluation Executive,The Atlantic Philanthropies

Design: Kate NorthernEditor: Alyson Metzger

The strategic learning and evaluation research underpinning this report and the work on helmet usage in Vietnam were made possible through generous grantsrom The Atlantic Philanthropies and others.

The Atlantic Philanthropies are dedicated to bringing about lasting changes in the lives o disadvantaged and vulnerable people. Atlantic ocuses on our criticalsocial problems: Ageing, Children & Youth, Population Health, and Reconciliation & Human Rights. Programmes unded by Atlantic operate in Australia, Bermuda,Northern Ireland, the Republic o Ireland, South Arica, the United States and Viet Nam. To learn more, please visit: www.atlanticphilanthropies.org.


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HELMET DAY IN VIETNAM:AN AMAZING, MAGICAL SCENE

19901996: STIRRINGS OF CHANGE

19972001: PREVENTION & HELMET USE COMING INTO FOCUS

20022007: MAKING & WEARING HELMETS

WHAT WAS DIFFERENT THIS TIME?

SUSTAINING & FINE-TUNING SUCCESS

LESSONS LEARNED: POTENTIAL APPLICATIONS TOOTHER PUBLIC HEALTH BEHAVIOR CHANGE PROGRAMS

APPENDIX: THE ACTORS IN VIETNAMS HELMET STORY


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On the morning o December 15, other dignitaries andI planted ourselves at the Daewoo Hotel intersection[in Ha Noi] with TV crews and other journalists. Wewanted to nd our or ve people who were not wearinghelmets, who could be lmed getting ned by police.There was no job or the police to do and nothing or TVto lm. . . . There was 100% compliance.

Bui Huynh LongSecretary, National Trafc Saety Committee

AN AMAZING, MAGICAL SCENE


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On December 14th, no one in all o Vietnam would have predictedthis enormous success. In Ha Noi, there was no stampede to buyhelmets. Certainly, almost no one had them on their heads. As the

work week drew to a close, it was mostly business as usual andtrac chaos as on any other Friday evening. There was a sense oanticipation among people working with helmet use projects, butno one was betting on anything. Nothing on the streets signaledthat the next morning would display such a radical change.

What made the achievement o Helmet Day possible? The journeywas not simple or easy. Multiple players contributed in a variety oways over many stages across several decades. Each particulartime period enabled or set up obstacles to each step taken.Forward action depended on two enabling actors: (1) the level opolitical will within the Vietnamese Government to come to gripswith what needed to be done and to both create needed regulation

and provide or its implementation, and (2) the coalescing ounding, passion, vision, and leadership among international andVietnamese actors to both promote and support necessary action.

While these elements were present in dierent ways at dierenttimes, only when both actors came together in ull measure diduniversal, compulsory helmet use come to pass.

Our Helmet Day story provides a lens on the process o creatingachievable policy and behavioral change and oers a set olessons learned that in whole or in part may be applicable toother public health issues and national settings where changingindividual behavior and culturally accepted norms o behavior isa goal. We share our experience in the hope that it will encourageand guide others who set out to prevent injury and illness inVietnam and elsewhere.

There was100%

compliance.

Motorcycle helmets became mandatory

in Vietnam on December 15, 2007.

When residents and visitors stepped

outside that Saturday, they aced a

beautiul, colorul sea o helmets onthe heads o the adults and children

riding by.


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When the American War ended in 1975, the Vietnamese began thedifcult task o reuniting their nation. The Doi Moi reorm processlaunched in 1986 has led to rapid urbanization and socio-economicdevelopment. By the mid 1990s, Vietnams economy was booming, withmost people switching with staggering speed rom bicycle to motorcycleuse. In urban areas, automobile numbers also burgeoned in response toeconomic growth. Vietnam seemed to be making a change to motorized

vehicles more rapidly than any other country in the world.

With motorization came trafc accidents, and with trafc accidentscame preventable motorcycle injuries and deaths. The need to changebehavior to somehow get Vietnamese o all ages to wear motorcyclehelmets was clear.

1Center or Injury Prevention and Policy Research, Study Report on Trac Injury Situation in Provinces o Yen

Bai, Da Nang and Binh Duong, drat, February 2008, Ha Noi School o Public Health.

2Asian Development Bank and Association o Southeast Asian Nations, Regional Road Saety Program Accident

Costing Report: The Cost o Road Trafc Accidents in Vietnam (Manila: ADB/ASEAN, 2003).

Traffic Accidents, Fatalities, and Injuries and Number of Motorcycles: 19902007

Accidents,

Fatalities,

Injuries(Thousands)

MotorizedVehicles(Millions)

Traffic Accidents Traffic Fatalities Traffic Injuries

Number of Automobiles Number of Motorcycles

35

30

25

20

15

10

5

0

25

20

15

10

5

0

1990

1994

1995 19

9619

9719

9819

99 2000

2001

2002

2003

2004

2005

2006

2007

Source: Authors based on data rom the National Trac Saety Committee and the Ministry o Transport.

The number o trac accidents in Vietnam increased signicantly each year rom 1990 to2002, as presented in the chart below. By the end o 2007, even though the number o tracaccidents had declined, the mortality rates and seriousness o injuries remained very high, withtrac accidents resulting in an average o 38 deaths a day and close to 14,000 or theyear 2,000 o them children. 30,000 cases o severe brain damage and head injury 6,000 othem in children were recorded. Trac accidents were the leading cause o death that yearor all people aged 1845 years.1

On the economic side, the Asian Development Bank showed, as early as 2003, that road accidentscost Vietnam at least $900 million each year, which was equal to 2.7% o Vietnams GDP. 2

Approximate Number of Motorcycles in Use Countrywide

Year

Motorcycles

1990

500,000

1997

3,000,000

1999

6,000,000

2004

14,000,000

2007

21,000,000


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THE ENABLING ENVIRONMENTUNDERSTANDING CONNECTIONS

In the initial wave o motorization, there was very littlemovement toward helmet imperatives. The Governmentsaw the emerging chaos on the roads as a problembut had not recognized the signicance o motorcycleaccidents or injuries and did not draw a connectionbetween accidents, serious head injuries, and helmets.The magnitude o the problem had yet to be realizedinternally, and external pressure had not yet come to bear.

POLITICAL WILL& GOVERNMENT ACTIONA LOCAL FALSE START& A NATIONAL CHAMPIONThis early period did see a brie local attempt at requiringhelmet use. In 1993, Ho Chi Minh City already acing adramatic rise in motorcycle accident injuries and deathsthat the rest o Vietnam would experience later mandatedhelmet use within the city. A year later, City authoritieshalted implementation and repealed the law. One explana-tion given or this about-ace was that the City exceeded itsauthority to regulate when there was no national helmetmandate. It was also reported that there were not enoughhelmets available amid public complaints about helmetcost and necessity. Bui Huynh Long, working in the legaldepartment o the Ministry o Transport on the rst nationalset o rules or trac order and saety, recognized the legalobstacle and included a helmet wearing clause but was un-able to promote it as a solution. However, Mr. Long emergedas a champion o the helmet cause and would become astrong partner or international players as their involvementand infuence grew around the helmet issue.

FUNDING, PASSION, VISION,& LEADERSHIPA GRADUAL REALIZATION

The rst stirrings o international interest in helmet usecame in 1991 with the establishment o the WHO/FIAFoundation Helmet Initiative, created to promote the use omotorcycle and bicycle helmets worldwide. Awareness wasspreading that needlessly large numbers o people werebeing killed or permanently disabled as a result o a headinjury received rom a motorcycle all or during a crash,head injuries that could have been prevented or been lesssevere through the use o a simple and inexpensive helmet.

The only signicant unding available or injuryprevention work in Vietnam at this time was bilateral aidthrough the Swedish International Development Authority(SIDA now the Swedish International DevelopmentCooperation Agency). In 1994, Vietnam and Sweden entered

into a ve-year health cooperation agreement to developa legal ramework or the health sector, in general, and toaddress accidents and injuries as urgent health problems.A Sae Community model was piloted by the Ministry oHealth, with the guidance o the models originator, Swedishproessor Lei Svanstrm. Promoted globally beginning in1989, the Sae Community model was seen as an eectivegrassroots solution or reducing injuries and accidents ineveryday lie at home, in school, and at work. Although aew pilot projects were carried out, universal, mandatoryhelmet use had not yet been identied as an urgentlyneeded solution.


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1997 was a year destined to change the direction o injury prevention work inVietnam. Two actors appeared on the scene who would stress that it was timeto stop the carnage on the roads and highways and time to put helmets oneveryones heads.

The 1st U.S. Ambassador ArrivesWhen the rst U.S. ambassador, Pete Peterson, arrived in Vietnam in1997, he began to raise the prole o road trac saety and helmetuse. Having lost a son in a trac accident, he was a man with apersonal passion or injury prevention work. He also believed thataccidents were a great waste o Vietnams resources and thereorea drag on development. But most o all, he wanted to save lives.Ambassador Peterson saw injury prevention as a non-controversialarea or U.S. participation and wanted to nd a way to build capacityinside existing systems. In 1999, he became a ounding member oThe Sae Viet Nam Initiative and years later created the non-protorganization The Alliance or Sae Children, dedicated to making theprevention o child injuries a reality in the developing world.

The National Trafc Saety Committee Is EstablishedThe Government created the National Trac SaetyCommittee (NTSC) in 1997 to advise the Prime Minister onstrategic and policy directions or ensuring trac orderand saety, coordinate public inormation and educationoutreach eorts, and report on the activities o ministries,sectors, and localities in perorming the work o ensuringtrac order and saety. A purely Vietnamese initiative, theNTSC would become a major partner to many internationalgroups that would come to work on the helmet issue.

1997A TIPPING POINT


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A national helmet use policy isurgently needed.

Ha Noi School o Public Health

Report to UNICEF on the 2001 Vietnam

Multi-Center Injury Survey

The ormation o the NTSC in 1997 was a major step orward ortrafc saety in Vietnam, and helmet-related activity grew indepth and breadth between 1997 and 2001. Despite an overallailure to achieve the desired mass impact, the various smallcampaigns carried out over this period may have helped easepeople into the idea o helmet use.

In 2001, as Vietnam was growing more receptive to a publichealth approach to reducing accidents and injuries, the PrimeMinister issued a decree establishing the Ha Noi School o

Public Health (HSPH) as a new agent o change to help developmodern public health. The frst sound research on which to baseinjury-related policy and public education and advocacy wasaccomplished that same year the 2001 Vietnam Multi-CenterInjury Survey. Funded by UNICEF and carried out by the HSPH incollaboration with the Ministry o Health, this was Vietnams frstnational household survey on injury and, at the time, the largestever accomplished in Asia. The Government initially balkedat accepting the results because they were more serious thanexpected but later would use evidence rom the report, such asthe accident rate, to underpin action.

THE ENABLING ENVIRONMENTSUDDEN AWAKENING & SOME MOMENTUM

This period saw a sea change in attitudes toward helmet use.There was a lot o energy, enthusiasm, commitment, andleadership shown by various international groups and individualsand their Vietnamese partners working on injury preventionand helmet-related programming. The snapshot o the periodwas o U.S. President Bill Clinton handing out the rst Helmetsor Kids to Vietnamese schoolchildren. This increase in interestand the growing number o players both inside and outsidethe Government began to produce orward momentum.Nonetheless, or every step orward there was oten a setback.

POLITICAL WILL & GOVERNMENT ACTIONMORE DRIVE BUT DISJOINTED ACTION

Although there began to be a signicant increase in politicalwill and government action around the helmet issue, withmore political actors joining the movement, legislative eortsbecame disjointed. The result was a pattern o legislation andimplementation attempts that lacked clarity and appropriatesanction, culminating in the National Assembly authorizing

the Government to stipulate helmet wearing within the 2001Law on Road Trac. While the Ministry o Transport becameengaged in the issue, other critical ministries did not join in orwere let out. The responsibility or controlling trac accidentswas still seen as the sole purview o the Ministry o Transportand the trac police, making it hard to orge the neededcooperation among the relevant ministries.

A major breakthrough came at the end o 2001 with theadoption o the National Policy on Accident and InjuryPrevention and Control or 20022010. A multi-sector NationalSteering Committee on Injury Prevention and Control ormed atthe same time, chaired by the Ministry o Health and includingthe Ministry o Transport.


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By the beginning o 2002, it was clear that both the Vietnamese Government and theirinternational partners were determined to develop mandatory helmet use regulations thatcould be successully implemented. Along with the act that in 2002 Vietnam recorded the mosttrafc accident deaths and injuries ever, the ollowing events made this year a tipping point:

AIPFs Protec HelmetFactory Opens

With the opening oa actory to produceappropriate, aordabletropical helmetsor both adults andchildren, AIPF began todevelop a high proleor non-prot helmetmanuacturing andmandatory helmet use.

A Strong Resolution Passes and the Party Engages

The Government approved Resolution No. 13 to check the risein and gradually reduce trac accidents and congestion. A ewmonths later, the Party became actively involved and issueda directive to strengthen leadership countrywide to solve theproblem o rising trac accidents, deaths, and injuries. Resultso both interventions included placing the Minister o Transportat the head o the NTSC and the Chairs o the ProvincialPeoples Committees as leaders o the provincial Trac SaetyCommittees. These ocials would now be held accountable orthe trac accidents, injuries, and deaths in their localities.

2002 A TIPPING POINT

A New NTSC SecretaryTakes the Lead

Bui Huynh Long whohad served on the NTSCin dierent positions since1997, emerging as a helmetuse champion assumedleadership o the NTSC, givinginternational groups workingon helmet use programsa passionate, committedgovernment partner.

FUNDING, PASSION, VISION,& LEADERSHIPJOINING FORCES

Alongside the growing domestic political will, a vibrantinternational community was developing aroundinjury prevention work and in particular helmet useprogramming. It was an unusual time, rich in peoplewho were highly motivated and completely committed

to success. Many more international groups alsobecame involved, pushed and prodded initially byAmbassador Peterson and Mike Linnan, the U.S.Embassy Health Attach or the Centers or DiseaseControl and Prevention (CDC). In 1999, Pete Petersonand Mike Linnan, in collaboration with the Ministryo Health and Morten Giersing, the UNICEF CountryRepresentative, started The Sae Viet Nam Initiative,a network o the NTSC, the Ministry o Health, otherministries and agencies, and a range o internationalorganizations, including Asia Injury PreventionFoundation (AIPF), UNICEF, SIDA, and the U.S. andAustralian embassies. (See the Appendix or a detailedlist o the many critical actors in Vietnams helmetstory over the years.)

American unding became an important actor, andhere too Ambassador Peterson served as a catalyst.Ater tapping the CDC and USAID or help, he andMike Linnan also convinced Chuck Feeney, the oundero The Atlantic Philanthropies (Atlantic), to invest ininjury prevention work and put him in touch with AIPFand UNICEF Vietnam. Atlantic gave its rst injuryprevention grants to the U.S. Fund or UNICEF (orUNICEF Vietnam) and AIPF in 2000, deeming AIPFsproject doable largely due to the grounding provided byThe Sae Viet Nam Initiative. As a condition o its grantmaking, Atlantics unding was matched by unds romthe corporate sector, oundations, and others. Securingthese unds took a great deal o patience, searching,

and negotiating, but in the end, bought a helmet actoryto produce appropriate tropical helmets in Vietnam.

VIETNAMS 1ST MANDATORY HELMET USE LAW

In this interim period rom 1997 to 2001, the basis was clearly establishedor a successul uture helmet use campaign. Necessary conditions werein place or a rst attempt at mandating helmet use, but they were not yetsucient to enable success.

The National Assembly gave the Government legal authority to mandateand sanction helmet use in the 2001 Law on Road Trac. However, this

covered only some roads and imposed only a minor ne. The trac policeorce was still too thin to cover even the ew selected highways wherehelmet wearing was compulsory, and police remained more interested inpublic order on roads than in public health.

There was not enough money or streetlights and compulsory helmetroad signs, let alone the necessary public education and awarenesscampaigns. While there was a Government budget or public educationat this time, we cannot say how much there was or how it was used topromote helmet use work. From the poor quality o the public educationmaterials we observed, it is probable that the overall budget was modest.

Quality helmets were still too expensive or most. Even though standardsor them were in place, AIPF had not yet started production o Protectropical helmets. The Ministry o Transports solution o setting up helmetrental booths where roads connected to national highways was noteective. With a low ne and little possibility o detection, many were willing

to risk riding without helmets.

From this rst attempt at mandating helmet use, the NTSC learned that ahelmet law without adequate nes, incentives or enorcement (includingenough police), and adequately unded public education would not besuccessul. Helmets had to be acceptable, and the public had to clearlyunderstand the need or them particularly in urban areas where mostmotorcycles were registered. New approaches needed to be ound.

Helmet use partners were also learning that they needed to improvetheir timing. The Government got ahead o itsel in declaring helmet usedecisions and campaigns, and AIPF got ahead o itsel in launching aHelmets or Kids program beore there was a actory to make them. TheNTSC reported that it did not have enough money to implement all theprojects in its rst road saety action plan.


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2001s ailed attempt at nationalhelmet wearing led to reassessmentand renewed energy. The Governmentgradually expanded the scope o the lawto include more highways and in2004 provincial roads. Complaintsabounded rom all quarters. Some saidthe law discriminated against ruralpeople and was intended to keep them outo the cities. On the other hand, urbanitesdid not want people to think they wererom the countryside and so did notvoluntarily wear helmets. People did notwant to be dierent in a social contextwhere conormity is highly valued.

Up to mid 2007, there was no clear,universal, mandatory helmet policy,despite the many resolutions, directives,and other legal devices put into play, andthere had been no consolidated outreachto change public perception o helmetuse. Both the Vietnamese leadership andinternational leaders and sta pushedthe edges as ar as they could go to bringabout the successul conclusion we knowas Helmet Day.

THE ENABLINGENVIRONMENT

AN INTENSIVE PUSHFOR SUCCESS

I the period between 1997 and 2001 hadseemed ull o new helmet use projectsand players, it was nothing like thecrowded eld that developed over thenext ve years. The number o peopleand organizations involved exploded,resulting in many major projects thatdirectly contributed to or had somebearing on the Helmet Day story. All the

relevant ministries were now engaged.The Party strongly signaled the problemas a priority. The media was taking up thecause, and local celebrities even becameinvolved. There continued to be startsand stops on the road to success, butall the actors believed the eort towardcompulsory helmet usage was rmly ontrack.

POLITICAL WILL& GOVERNMENT ACTIONWORKABLE LAWS &SERIOUS IMPLEMENTATION

Government eorts beore 2002 wereunilateral and did not have the supporto all relevant bodies. From 2002 on, theGovernment agreed that helmets wouldbe worn on national highways that postedsigns stating that helmets were required,and this became the law. Signs wereposted, and nes were imposed on somehighways. Regulating only nationalhighways and provincial roads coveredabout 18% o Vietnams road system,missing the cities where motorcycle usewas highest. Local leadership varied,so action and enorcement were notconsistent rom one locale to another.Helmet usage was growing, but due to thelack o universality in what was requiredon which roads and the unevennesso sanctions and their enorcement, itremained the exception, not the rule especially in the cities.

Shortly ater the NTSC under Mr.Longs leadership presented a well-crated National Helmet Action Plan,Mr. Long and the Minister o Transportleveraged Vietnams expression o strong

support or the APEC Road Trac SaetyResolution to engage the attention andsupport o the Prime Minister or theirhelmet plan. In mid 2007, the Governmentunanimously agreed helmet wearingwould be compulsory or all romSeptember 15th on all national highwaysand then rom December 15th on all roads.The national universal helmet policy wasissued at the end o June in GovernmentResolution No. 32, which also includeda number o urgent measures to controltrac accidents and congestion. Thisresolution triggered the chain o events toensure all related laws and subordinatepolicies conormed. The sanction lawwas amended, and nes were beeed upsignicantly.

The political will that led to theGovernments helmet policy extendedto the Party, a largely missing elementin earlier periods. Provincial PeoplesCommittee Chairs (the highest rankingparty ocials in provinces and theequivalent o governors) became theheads o local branches o the NTSC, thuslodging responsibility or trac saety,injuries, and mortality squarely with thoseleaders responsible or implementingnational policy at the local level. In August

2007, the Party issued a report thatarmed that road saety is a politicaltask and a mass task and stated thatall must comply with and implementResolution No. 32. This was the authoritythe Prime Minister needed to issue aormal directive to all branches, agencies,oces, and political-social organizationsat every level to mobilize them to makesure everyone knew about the rules andthe nes and would be wearing theirhelmets on December 15th.

In early 2007 only 3% o the populationwore a helmet when on a motorbike.

Greig Crat

President, Asia Injury Prevention Foundation3

3 Greig Crat, Roadmap or a Successul Helmet Wearing Initiative, 20072008, unpublished, AIPF, 2008.


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FUNDING, PASSION,VISION, & LEADERSHIPEXPANDING NETWORKS,EVIDENCE, & EDUCATION

The key policy shit or helmet usagewas greatly enabled by a signicantincrease in the number o playersinvolved in the helmet use movement.

The international, national, and localsynergy electried the participants.The interaction among the three levelscontributed to the development o anempowered and impassioned localmovement that accomplished its missionon Helmet Day. I there was a tsunamio legislation during this time period, itwas equaled by the level o programmingthat occurred. While not always wellcoordinated, planning and organizationincreased signicantly. Individuallyand collectively, the many playersaccomplished a great deal and helped theVietnamese Government and the Party

push on to Helmet Day. One o the mostimportant leaders to join the eort in thisperiod was the Prime Minister, who lenthis personal prestige and moral suasionto the movement and by his personalinvolvement set a positive example orgovernment ocials.

Signicant donors joined Atlantic inunding the work in Vietnam ater theUN adopted the 2005 General AssemblyResolution on Improving Global RoadSaety, which prescribed helmet use,among other important measures. Thenetwork o organizations that supported

the UN resolution began to look atVietnam as an initial site or its applicationand saw AIPF as an able acilitator. Thisled to the World Banks Global RoadSaety Facility (GRS Facility) and theBloomberg Family Foundation becomingtwo key new donors.

The GRS Facility would use Vietnam tospearhead a teen-year road saetyproject, intended to become a modelproject or the world. The rst phase budgeted at $31.7 million was approvedin 2005, with a small helmet-related pieceinvolving road user education. This wasin addition to work that the World Bank

was already doing through the GlobalRoad Saety Initiative (GRSI). Since 2002,the GRSI had been running programsin Vietnam through its internationalcoordinator, the Global Road SaetyPartnership, which partnered with AIPF. Itwould later select Vietnam as one o thecountry beneciaries o its $10 millionunding rom Ford Motors, General Motors,Michelin, Renault, Shell, and Toyota.

The Bloomberg Family Foundation gaveWHO $9 million to support its new GlobalRoad Saety Program mandate, the resulto a 2004 WHO resolution on road saetyand health. WHO allocated $860,000to Vietnam to work with the Ministry oHealth on helmet use.

There was much collaboration andcooperation among unders and advocateson communications and education work.SIDA continued to und the Ministry oHealth to carry out the Swedish-VietnamSae Community collaboration through2007, and aliate Sae CommunityNetwork Members all participated inhelmet use training and education. Atthe beginning o 2006, the programproduced national guidelines on criteriaor awarding sae amily, sae community,and sae school certicates that includedhelmet wearing.

As in previous periods, AIPF was alinchpin. The organization provided ree

helmets and a saety demonstration toone o the Sae Community schools andwas also a member o a Make RoadsSae campaign coordinated by the FIAFoundation. That coalition had lobbiedhard or the government resolutions and guided by AIPF brought spokespersonMichelle Yeoh to Vietnam to promotehelmet use.

The Center or Injury Prevention andPolicy Research (CIPPR) at the Ha NoiSchool o Public Health inspired themovement by helping to provide answersand evidence related to the issues. CIPPR

mobilized the HSPH and the Viet NamPublic Health Association to support earlywearing o helmets (rom September 15th).

There also continued to be no shortageo individuals with passion, vision, andleadership abilities. New advocates joinedwith old hands, none o whom droppedo the track as the work continued. GreigCrat o AIPF, in particular, brought ahuge passion or the helmet use issue tohis work. His belie that a private-publicpartnership could result in a viable non-prot helmet actory kept AIPF goingthrough extremely trying times or the

actory.

ACTION COALESCESAT KEY MOMENTS

AIPF and the rest o the nascent networkjoined orces at two pivotal moments duringthis period. The rst key moment was theNational Helmet Action Plan Workshop inDecember 2006. Co-chaired by the GlobalRoad Saety Partnership and the French

Red Cross, the workshop was organizedby AIPF and the NTSC. The 2006 WHOpublicationHelmets: A Road Saety Manual orDecision-makers and Practitioners, availablein Vietnamese, provided a ramework orplanning Helmet Day. Mr. Long, Secretaryo the NTSC, was convinced enough othe soundness o the resulting NationalHelmet Action Plan and the backing othe international players that he proposedDecember 2008 to the Government as thestart o mandatory helmet wearing. We believethe action plan inspired the Governmentsadoption o helmet wearing nationwide withinResolution No. 32 and directly infuenced thePrime Ministers approval.

The second key moment was the nationalhelmet wearing campaign held in March andApril 2007. Greig Crat, AIPF President, choseto try a new approach to public educationand worked closely with Ogilvy & Mather(Vietnam) on an extraordinary campaign calledEnough is Enough and No Excuses . . .Wear a Helmet. Launched during the rst UNRoad Saety Week, the campaign was madepossible by unding rom the National HelmetWearing Coalition, which was made up ointernational groups, embassies, and othersthat Mr. Crat had asked Klaus Rohland at theWorld Bank to pull together to raise money.The campaign would go on to win an awardor communications work. The NTSC creditsAIPFs education campaign or infuencing

the Government to move up the date ormandatory helmet use to December 15, 2007.

PHOTOCREDIT:

NINAR.

MCCOY,

SSRC

PHOTOCREDIT:JACKIEWILLIAMSKAYE,

THEATLANTICPHILANTHROPIES


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The immediate success o Helmet Day caused a stirthat lasted through the month and well into 2008.All the involved parties had worked extraordinarilywell together. There was inspiration all around, andthe Prime Minister had shown encompassing, trueleadership.

The 98% to 100% compliance rate in both cities andthe countryside shocked everyone. Da Nangs helmetuse went rom about 4% to 98% overnight.4 Ha Noi andHo Chi Minh City were closer to 99%.5 Many groupsthat had worked to make this happen expected rom50% to 80% compliance. Atlantics Country Manager,Le Nhan Phuong, had hoped or 70% but would havebeen happy with 50%. AIPF anticipated 70%. CIPPRhoped or 60% to 70%.

The entire exercise in behavior change was anenormous accomplishment, a victory over the manyobstacles to mandatory helmet use. There is no wayto count the amount o time, energy, and physicaland nancial resources that went into the lead upto Helmet Day. It is clear that it all cost more than

might have ever been imagined by the primaryplayers. That it surprised them all in its successsays a great deal. The results o the day itsel andthe days ater deserved the attention they received.The Government, people, and partners o Vietnamachieved results that most developing countriescould only dream about. That helmet use wouldneed to be ne-tuned was certain, but that was alsonormal and anticipated. The overall achievement othe day was not normal at all. It remained wondrousor some time beore the ne-tuning had to begin inearnest.

4 Ian Scott, The Alliance or Sae Children, June 2008 interview.5

Bui Huynh Long, National Trac Saety Committee, August 2008

interview.

What was dierent about Vietnams secondattempt at universal helmet use? What wasit in the fnal push that made Helmet Daypossible? For over ten years, multiple actorscontributed in a variety o ways. Certainconditions were created, some o whichwere necessary but not sufcient. Change

happened only when the necessary and thesufcient coalesced.

All the organizations that we talked to agreedon most o the reasons or the success ouniversal mandatory helmet wearing thistime around. Grounded in an overall increasedintensity and momentum, they include:

PHOTOCR

EDIT:ASIAINJURYPREVENTIONFOUNDATION

An enhanced legal, administrative, and social environment AND arule or changing behavior that was:

Based on sound datasupporting the need or urgent action. Issued by the highest political authorities: the Government,

the Party, and the National Assembly. Communicated as an eective, urgent solution. It was

cleverly packaged within Resolution No. 32, which was notjust about helmet wearing but described urgent solutions totrac crises, trac jams, and congestion.

Clear to understand, communicate, and enorceverbally,visually, and in writing: ALL motorcycle riders and drivers onALL roads.

Universal. Backed by a mix o coercive and social sanctions, deterrence,

and incentives. The nes cost more than a helmet. Beingstopped or not wearing a helmet exposes a rider to beingchecked or other violations. The inconvenience o thepaperwork and the time o required to pay nes at theTreasury oce are also reasons to comply.

Modeled by leaders and persons o authority.The Ministero Transport ordered his entire sector to comply beore thedeadline. He abandoned his car and rode his motorbike towork, wearing his helmet, on December 15th. Party leadersand civil servants signed commitments to abide by thehelmet rule and other trac saety rules.

Enorced by all,with a determination to catch any violator. Theenorcement machine was out in orce. Police and Youth Unionvolunteers were on about every street corner in the cities. Thenumbers and types o police with authority to stop violators

and levy nes increased exponentially. For example, 95,000commune police workers joined the enorcement. Governmentworkers were brought into the loop with tasks and deadlines.Deans and principals were responsible or managingstudents, ensuring their compliance, and discipliningviolators. The Ministry o Health, the Ministry o Transport,and many other ministries and provincial authorities directedworkers to sign commitments to wear helmets, with violatorsto receive no end-o-the-year perormance recognition orawards.

Strategically timed and phased in. September was designatedocial Saety Month, with helmet wearing compulsory onall national highways beginning on September 15th. Thenational highways are managed by the central government,


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WHAT WAS DIFFERENTTHIS TIME?

which has more human resources and money than otheradministrators, allowing or tough enorcement thatsignaled the central levels will, intent, and power to thelocal authorities and the general population. Success inSeptember gave the Government and helmet use advocatesmomentum to proceed with the national campaign.December was chosen or the launch o universal helmet useon all roads based on ndings that helmet compliance washigher during winter.

Publicized and disseminated by mass media and every othermeans, with the aim o reaching every person at every levelo society, rom the cities to the mountains. Every step o theway, every piece o law and directive was made known to thepublic.

The means to comply through:

The availability o appropriate helmets. Many manuacturersengaged in producing helmets, and helmets were generallywell distributed and available throughout the country. Thereseemed to be enough dierent styles that people could ndwhat they wanted. The Protec actory showed it was possibleto make tropical helmets that are not hot, heavy, or ugly andgave their design plans to other companies to expand helmetsupplies and availability.

Verifable quality and prices. The Government checkedhelmet quality and price and posted lists o those helmetproducers who passed inspection and those who did not.State-owned enterprises were ordered to keep prices low.

Subsidies and employee benefts. Thousands o civil

servants as well as private sector workers receivedhelmets or money to purchase them rom their employeror organization. Corporations and actories distributed reeor subsidized helmets to their sta, oten with logos anddesigns. Protec made customized helmets or organizations,including the Ha Noi School o Public Health. Companiesmade Helmet Day a estival.

Free helmet programs. The Government distributed 50,000ree helmets to the very poorest. Other organizationsprovided ree helmets as well. As o June 2008, Helmets orKids had distributed 350,000.

Opportunities or innovation and resourceulness. Theinsurance industry marketed personal injury and liabilityinsurance along with a helmet or the same price, a 2-in-1

Insurance Helmet. People started decorating their helmets,and young people began investing in several ashionhelmets. People quickly solved the problems o where tostore helmets and how to protect them rom thievery.

Strong education and awareness eorts, with a clear messagethat was:

Communicated by creative and prolonged campaigns.There was an early, creative, and hard-hitting educationcampaign rom AIPF and the NTSC. The messages wereclear and tough because they were about real people withhead injuries. It was planned careully over more than ayears time. It used new ways o getting messages across.It worked well enough that the Prime Minister was deeply

moved by the TV ads and pushed up the date or complianceby an entire year, rom December 2008 to December 2007.The Government had monthly campaigns and then went allout the week beore Helmet Day.

Funded by donors and the Government. AIPF was able tomobilize the Danish, Australian, and U.S. embassies, Intel,Michelin, the World Bank, the Asian Development Bank, andWHO to support the helmet use communications campaign.

Intended to reach everyone. Through the reach o massorganizations, everyone knew what December 15th meant.They also knew the consequences o not wearing a helmet:physical, legal, social, and nancial.

Eective planning and coordination, rom the top to thegrassroots:

Everyone involved pulled together, including the Party, theGovernment, mass organizations at all levels, the HSPH,schools, researchers, the UN and bilateral agencies, andinternational and local NGOs.

The Prime Minister directedthe campaign to its success andbeyond.

The NTSC provided very careul planning, including adetailed set o tasks or each ministry and their departments,with deadlines and a report-back scheme. No one wasallowed to drop the ball, and everyone was supported.

Mass organizations mobilized zealously rom the grassrootsup.Everywhere, Helmet Day used excitement to get people toput their helmets on. It was a un day o collective action.


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A new cultural characteristic wasestablished.

Saigon Giai Phong newspaper

December 16, 2007


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Two years later, the sudden and dramatic behavior changeseen on December 15, 2007, has become the norm. Accordingto a Ministry o Health/WHO road observation study in Yen Bai,Da Nang, and Binh Duong, helmet usage has not signifcantlydiminished as one might expect. The fgures or driverswearing helmets were 91.7%, 86.3%, and 98.5%, respectively,by the end o May 2009. The percentages o passengerswearing helmets were somewhat lower at 81.1%, 86.3%, and91.6%, but overall the observed usage changes were positive.6These rates are representative o other provinces, some owhich have even higher compliance. By November 2009, thehelmet use rate or adults was still around 90%.7

Ater the success o Helmet Day, the coalition o domestic andinternational players remained committed and was able toorge ahead to sustain the behavior change already in place,expand helmet usage, and enhance health outcomes. Withusage remaining up, the coalition was able to ocus attentionon some o what had been considered second-order issues helmets or children, helmet quality, properly worn helmets,and monitoring. Real progress has now been made in severalcritical areas.

HELMETS FOR CHILDRENWhile almost all children wore helmets on December 15th,within ten days, childrens helmet use ell to no more than 20%ater a media report cited the opinion o a medical practitionerthat helmet use might increase the risk o neck injuries.Unortunately, even without evidence, parents believed thesereports, and almost overnight helmets disappeared rom mostchildrens heads. We now know the medical proessional waslikely misquoted, misunderstood, and misreported, but theerroneous negative opinion spread throughout Vietnam.

Parents and young teenagers also quickly ound out that therewere no nes or children under age 16, and nes or driversand riders aged 1618 were only hal the adult ne. From

age 16 up to their 18th birthday, minors can operate a moped oless than 50cc, with no license required. The sanctions in placeor this large group o teenagers have not been strong enoughto get them to wear helmets, even though operators o thisclass o vehicle are still bound by all requirements o the Lawon Road Trac. Financial penalties or not wearing helmetsare requently not administered to this group. Instead policeinorm the school at which the youth is registered, and the typeo punishment (requently some orm o academic punishment)is deerred to the school.

6Vietnam Ministry o Health and WHO, Report: Helmet Observation in Yen Bai, Da Nang

and Binh Duong, May 2009 (Ha Noi: 2009).7 Jon Passmore and Nguyen Phuong Nam, WHO, October 2009 interview.

8 Vietnam Ministry o Health and WHO, Eect o Mandatory Motorcycle Wearing onHead Injuries in Vietnam, unpublished, August 2008.

ENHANCING HEALTH OUTCOMES

The Ministry o Health with WHOs technicalassistance carried out monitoring at 20provincial and central hospitals over three monthsbeore and ater Helmet Day. Results showed adecrease o 24% in patients admitted with headinjuries and 14% in road trafc deaths.8 OtherGovernment monitoring reports rom the frst

six months o mandatory helmet use supportedthese fndings.

While universal mandatory helmet use wasclearly having a positive eect on healthoutcomes, many more people would have beensaved i they had used helmets correctly. Thus,

continued work is indicated in three key areas:

HELMET AVAILABILITYSae, aordable helmets have to be accessible in all sizes orpersons o all ages and incomes.

Helmets or children and inants need to be morewidely available.

A way to provide helmets to the poorest segmento the populationhas to be ound, including possiblyrequiring helmet manuacturers to give a percentage otheir production to a und or the poor.

HELMET STANDARDS & QUALITYLarge numbers o helmets do not meet the Governmentshelmet standards, providing users with alse security.

Helmet quality mandated through the NationalStandards or Helmets must be applied to all helmets inVietnam and ully enorced.

The market needs to be better monitored. Thehelmet trade needs to be better understood andcontrolled. This relates to importation and smugglingas well as local manuacturers. Problems keeping upwith demand or new quality helmets may arise or

there could be market over-saturation it will be hardto predict which and when. Coordination on qualityinvolves three ministries, and no one seems able tocontrol the helmet sources or the retailers.

Side eects o helmets, health problems or skindiseases especially with regard to substandardhelmets need to be explored. Some inerior helmetshave contributed to acial injuries. Others can make thewearers head very hot and sweaty, are unwashable andquickly become smelly, and/or have aulty clasps.

Standards or helmets used on high-speed highways

need to be reassessed. An enhanced regime o product liability and

consumer protection needs to be developed.

SAFE & EFFECTIVE USEDespite all the education around Helmet Day, many

people wear helmets in incorrect and dangerous ways.On January 3, 2008, Vietnam News online reported a surveynding 88% o users wearing helmets incorrectly: (1) notbuckling the strap, (2) putting the helmet on badly, (3) wearinga too-loose strap, or (4) wearing the helmet over or underother hats.

Failure to wear helmets correctly must be penalizedi helmet use is to be optimally eective.

Parents need enhanced training in how to t childrenshelmets.

Medical proessionals need education in properhelmet use to avoid misinorming their patients and thepublic at large.

Warning labels and instructions or useshould berequired to be provided with every helmet.


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Getting children to wear helmets became the ocus or concertedaction over the next two years. It took time to realize that thestory o possible neck injuries could not just be talked away, thatparents deeply undamental belie in it would not just disappear.In response, the coalition decided to accelerate work in twoareas: (1) with the Government to remedy the nes loophole inthe law that essentially allowed children to go without helmets,and (2) in public education targeted to parents.

As a result, the Government approved a new schedule o nes

in Decree No. 34, issued on April 2, 2010. Eective May 20, 2010,the new decree nes the driver when any passenger aged 6 orolder is not wearing a helmet or does not have the helmet strapastened. Thus, adult drivers are now held accountable or thehelmet use compliance o their child passengers. The decreewill also make it easier or authorities to enorce child helmetusage through schools and parent associations, and police canreach these groups or training. Schools can be marked downon perormance ratings i their students do not comply. In turn,schools can require parents to assure child helmet use. Thedecree is not perect, but it is a place rom which to build in theuture.

Fines or passengers under 6 are still not covered by the decree.While WHO understands that all children should wear helmetsand has pressed the Government on this, they also believethey have pushed as much as they can just now to get newsanctions or childrens helmet use approved. They recognizedthat helmets or children 6 and older was the best that couldbe achieved in 2010, given that many parents and leaders stillremain apprehensive about helmets on younger children.

Public education targeted to parents has included public serviceannouncements made by AIPF to correct the medical evidence.In the attempt to move to helmet wearing or saetys sake (not

just to avoid nes), a required school-based drivers educationprogram or youth between 16 and 18 years old could be thevenue or sae driving training related to helmets and otherissues. In this context, lms can be o great use. This could beexpanded beyond the school context or rst-time licensees whoare not in school.

HELMET QUALITYIn November 2008, the existing adult and child helmet standardswere revised into a single consolidated, government-approvedNational Standards or Helmets. Enorcement is, however, veryweak, with too many helmets o extremely poor quality in shopsand on heads. Some measures to be taken include crackingdown on illegal and substandard helmets at the manuacturing

and distribution points and having police become more active inning people or using them.

Protec has developed suitable and sae helmets or children including those under 6 and to urther encourage theiruse, has expanded the styles available. Protec reports that itssmallest helmets t some children as young as 6 months old,depending on the head orm. Helmets or children 5 and olderare also available through other companies, including Hondaand Zeus. Still, according to AIPF, Protec is the only legitimate

producer in Vietnam o the smallest helmets, and that is notexpected to change with the new decree, as the continuedlack o a market or children under 6 will not encourage otherproducers.

PROPERLYWORN HELMETSSome helmet wearing is clearly to avoid nes and not or saety.By the end o August 2008, there were many people with helmetswith unbuckled straps riding around on the streets o Ha Noi.

In response, in November 2008 the Ministry o Public Securityput out a circular equating unastened helmets to no helmet atall and stipulating hety nes or drivers and passengers whodont use their helmet straps. Application o this new regulationcan be credited with a noticeable increase in the number oproperly astened helmets.

MONITORINGIn October 2007, to help evaluate the eects o helmet use overtime on morbidity and mortality resulting rom accident-relatedinjuries, the General Department o Preventive Medicine andEnvironmental Health, o the Ministry o Health, developed amonitoring project to ocus on trac injuries particularly headinjuries, helmet use, and helmet quality beginning with 20hospitals. This was later expanded to cover 100 hospitals in 63provinces and cities.

Monitoring occurs in the emergency departments o most othese hospitals. WHO helped roll out and supports this project,including doing training in the hospitals. There are unresolvedproblems with the project: lack o dedicated sta, bias romsel-reporting by accident victims or amilies, and a lack olinkage between this monitoring and that done by the police.Accurate data collection is urther complicated by the act thatan admission o not wearing a helmet can result in an insurancecompany reusing to pay or hospitalization.


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While the strong and united coalition has accomplished a greatdeal in the two years since Helmet Day, there are still too manypeople wearing helmets incorrectly and some not wearing themat all. In Ha Noi ewer drivers (especially the young and hip) wearhelmets on the weekends, at night, and on back streets becausethere are not as many police around to enorce the law. Toomany people buy poor-quality helmets still ound in the marketsdespite strengthened helmet standards. The smallest childrenare still not required to wear helmets. Helmetless bicyclists

remain at the mercy o ast-paced cars and motorbikes.Enorcement can be spotty on less-traveled roads outside thecities. Most problematic or long-term behavior change, thesaety benets o helmets are still not ully understood.

There is much yet to be done to urther enhance healthoutcomes and expand helmet usage through the our keybuilding blocks that enabled change to be sustained andenhanced over the past two years:

Development o datato add to the evidence base ormandatory universal helmet use, including a way to quicklyaddress alse rumors about the dangers o using helmets.

Education and awareness programming,including work toenhance media knowledge and improve reporting.

Legal capacity buildingto ensure that subsequent policychange is institutionalized in a clear, comprehensive set orules, nes, and enorcement measures.

Monitoring through a better national program to documentthe benets o helmet wearing and also provide eedbackor legislative renement, public education, and legalenorcement. This includes helmet monitoring in the

countryside to measure enorcement, levels o poverty, andguaranteed access to helmets.

What is most important is that Vietnam now has a strong modelor collective mobilization o government and society or injuryand illness prevention. This can be replicated as the authoritiesand their national and international partners search or waysto internalize these our tasks so that they become a normalpart o the continuous eort to ne-tune the system. The moretime that passes, the harder it will be to maintain momentumand maximum eort. Thus, tasks such as these must becomeaccepted as standard to the way government and societyinteract.


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THE PRIMARY LESSON OF THE HELMET DAY STORY IS THAT POLICYCHANGE CAN BE AN IMPORTANT ELEMENT IN BEHAVIORAL CHANGE,ESPECIALLY IN AN ENVIRONMENT, SUCH AS VIETNAM, WHERE THEGOVERNMENT IS A MAJOR PLAYER. It is more complex though thansimply making a law and providing or its implementation. TheGovernment set the policy target, became thoroughly committedto the cause, acquired the knowledge about implementationstrategies, and mobilized all the other parts o the State toachieve the goal. At the same time, there were additional peopleinvolved who driven by a passion or the work brought money,knowledge, and leverage to the mix. They knew how to makethings happen, were risk-takers when they needed to be, and hadthe experience to step back and imagine the results. These peoplewere, in this context, a mixture o Vietnamese and internationalactors whose skills and knowledge were complementary.Planning and coordination among these players was critical sothat essential actors could come powerully together. Withoutthat eventual synchronization, ailure was likely.

THE SECOND CRITICAL LESSON DRAWN FROM OUR EXPERIENCEIN VIETNAM IS THAT INITIAL CHANGE MUST BE SUSTAINED ANDSUPPLEMENTED.The initial change will always be imperect. Therewill always be the need to sustain and ne-tune policies andbehaviors ater the initial change takes hold. It is important toplan or this rom the outset and not attempt more than is doable.The initial ocus o attention in Vietnam was on getting appropriatehelmets on most heads. This was seen as the rst step, withsecondary attention to issues such as helmet quality, proper use,and sustainability o the eort. We believe that, whether handledin phases or thought through all at once, a behavior changestrategy that aims or mass adoption must be coupled with astrategy and action plan or sustaining change and enhancinghealth outcomes in the longer term. In our case study o changingbehavior around helmet use in Vietnam, we see the gradualevolution o a well-thought-out plan or getting everyone to wearhelmets. We do not see a similar plan or sustaining the changeand addressing anticipated and unanticipated second-orderchallenges. Developments ater the initial success o Helmet Dayrevealed some remaining barriers and emerging challenges thathad to be addressed in particular, getting helmets back on theheads o children.

There was a coalescing behinthe notion o helmet law andhelmet use. The involvemento many players had fnallygrown into a movement thathad more clout, and theVietnamese players were moro a collective orce than everbeore.

Le Nhan Phuong

The Atlantic Philanthropies

PRIMARY LESSONS

In the lead up to Helmet Day, the strong Government desire to legislate on this matter and their ability to develop and implementa logical legal rame had fnally come together. At the same time, sufcient resources were available including passionate andknowledgeable leaders and unders, both Vietnamese and international to provide the underpinnings that would enable behaviorchange. In a departure rom the dualism that can too oten undermine eective collaboration, international participants playedpositive roles both externally, bringing pressure and unding to bear around the problem, and internally, engaging ully on the groundto create and support coalitions that could drive achievable solutions.

There are many lessons rom Vietnams helmet story that can be applied to other public health issues that involve programming tochange embedded socio-cultural norms and individual behavior. Below we present our preliminary thoughts. We look orward tourther brainstorming on what we have learned and what might be useul in developing behavior change programming or otherinjury prevention and public health areas in Vietnam and elsewhere.


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THERE NEEDS TO BE A CREDIBLE, UNDERSTANDABLEKNOWLEDGE BASE. Evidence provides a oundation orgovernment and advocate commitment and stimulatespublic awareness and engagement.

CULTURAL CONTEXT IS CRITICAL.Changing norms o behaviorand sustaining the change requires an understanding osocio-cultural enablers and barriers. Social conormityis strong in Vietnam and blocked any signicant earlyadopters or voluntary change. Vietnamese oten do notwant to stick out rom the crowd. This makes it hard to be therst ones to do something dierently. In the case o helmetuse, many people did not want to be the only ones wearingthem, even i they knew they should do so. Having everyonedo it at once was a acilitator.

A COMPULSORY ELEMENT IS OFTEN ESSENTIAL TO CHANGINGRISKY BEHAVIORS. It takes money and time to develop andne-tune eective rules to limit injury and illness. Thisincludes compulsory use o lie jackets, seat belts, andchild seats; standards or buildings; saety codes to preventburns and poisoning; and smoking bans in certain indoorenvironments. It is important to be creative in thinkingthrough scenarios and testing new policies and regulationson the public. Thereore, public health saety programscan take a decade or more to build, and unders and otherstakeholders need to be prepared to engage long term.

ANY REGULATION MUST BE CLEAR AND EASY TOUNDERSTAND AND WELL COMMUNICATED.Regulationneeds to be communicated unambiguously in policy andlegal documents, taught in schools and other communityorums, dramatized in songs and plays and other publicperormances, disseminated accurately by mass media, orconveyed through everyday conversation. Regardless o itsmeans o delivery, the message about the desired action

and the consequences or not complying (social, health,nancial, and legal) must be clear to those who are expectedto act. These consequences must also be clear to those whoare to enorce or reinorce that action through police work,social sanction, or other penalties or incentives.

ALL ESSENTIAL PIECES OF LEGISLATION MUST BE IN PLACEAT THE SAME TIME the legal authority, the rule, and thesanction, as well as the instructions or implementationand enorcement.

EDUCATION AND COMMUNICATIONS MUST BE APPROPRIATETO THE AUDIENCE AND CULTURAL CONTEXT, CREATIVE,CLEAR, REPEATED, TRUTHFUL, AND LINKED TO EVIDENCE.For example, behavior change messages ocusing on

children can help reach adults. Active teaching methodologycan be eectively used, but the message needs to stand out.Programs need to be piloted and tested to avoid unexpectedresults that then have to be retracted. While essential,community awareness programs are sometimes hard tound and government approval can take a long time.

EDUCATION AND COMMUNICATIONS EFFORTS MUST BESIMULTANEOUS AND CONSTANT.

CAPACITY-BUILDING AMONG KEY PLAYERS IS ESSENTIAL.Knowledge is increased through cross-ertilization,brainstorming, collaboration, and the sharing o ideas.Eectiveness can be exponentially expanded throughmutual support o eorts.

LOCAL-INTERNATIONAL PARTNERSHIPS BOTH DEVELOP NEW

AND ADAPT OLDER BEST PRACTICES.Such partnerships alsoput pressure on authorities to keep up momentum as wellas attracting unders to the issue. This can help expediteproject implementation.

GLOBAL-LOCAL INTERACTION CAN AMPLIFY MESSAGING.Global emphasis on an issue can assist governmentsin achieving their goals. In Vietnam, UN interest inand support o the helmet use issue was used by theGovernment to call attention to the project and moveit orward. Reciprocally, the programs successulimplementation brought praise or the leadership andeectiveness o both the Government and the globalcommunity, enhancing their legitimacy.

PRIVATE-PUBLIC PARTNERSHIPS CAN BE BUILT TO FUNDAND IMPLEMENT INJURY PREVENTION AND OTHER PUBLICHEALTH PROGRAMS.These partnerships were embracedby the Vietnamese Government, which actively promotessocialization, or the participation o all in producingpublic goods. AIPF itsel was a private-public model andunded the Protec actory that way. It also successully drewcorporations into supporting trac saety education andthe Helmets or Kids program.

ADDITIONAL LESSONS

Additional lessons learned that could be potentially applied to other public health behavior change programs include the ollowing:


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LOCAL ACTORS

Ministry o Health

Ministry o Transport

Ministry o Home Aairs (now the Ministry o Public Security)

Government Committee on Organization and Personnel (now theMinistry o Home Aairs)

Trafc Saety Steering Committee (replaced by the National TrafcSaety Committee in 1997)

Health Policy and Strategy Institute

The Peoples Committee o Ho Chi Minh City

Nguyen Van Thuong, Deputy Minister, Ministry o Health

Bui Huynh Long, Ministry o Transport

INTERNATIONAL ACTORSSwedish International Development Authority (now the SwedishInternational Development Cooperation Agency)

WHO/FIA Foundation Helmet Initiative

Lei Svanstrm, Lund University, WHO Collaborating Centre onCommunity Saety Promotions, Karolinska Institutet


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LOCAL ACTORS

National Assembly

Ministry o National Deense

Ministry o Finance

Ministry o Justice

Ministry o Education and Training

Ministry o Science and Technology

General Department o Preventive Medicine and HIV/AIDS (rom 2005 to2007 the Vietnam Administration o Preventive Medicine; rom 2007 to2009 the General Department o Preventive Medicine and EnvironmentalHealth; and now the Department o Preventive Medicine), Ministry oHealth*

National Trafc Saety Committee

National Steering Committee on Injury Prevention and Control

Viet Nam Committee or Population, Family and Children

Provincial and municipal Trafc Saety Committees

Police

Ha Noi School o Public Health*

Viet Nam Red Cross

Viet Nam Fatherland Front, Viet Nam Farmers Union, Viet Nam WomensUnion, and other mass organizations

Nguyen Tan Dung, Deputy Prime Minister (September 1997May 2006),Prime Minister (June 2006current)

Nguyen Trong An (currently Deputy Director, Department or ChildrenCare and Protection, Ministry o Labour, War Invalids and Social Aairs)

INTERNATIONAL ACTORSAustralian Embassy

U.S. EmbassyU.S. Centers or Disease Control and Prevention

USAID

U.S. Fund or UNICEF*

UNICEF*

The Atlantic Philanthropies

The Sae Viet Nam Initiative

Harborview Injury Prevention and Research Center,University o Washington*

Pete Peterson, U.S. Ambassador

Mike Linnan, Centers or Disease Control and Prevention, HealthAttach, U.S. Embassy

Michael Mann, Australian Ambassador

Chuck Feeney, The Atlantic Philanthropies

Chris Oechsli, The Atlantic Philanthropies

Morten Giersing, Country Representative, UNICEF Vietnam

Huan Linnan, The Sae Viet Nam Initiative, UNICEF

Greig Crat, ounder o Asia Injury Prevention Foundation

Le Nhan Phuong, Ha Noi School o Public Health,The Atlantic Philanthropies

Charles Mock, Harborview Injury Prevention and Research Center

U.S. President Bill Clinton

LOCAL ACTORS

The Communist Party o Vietnam, Politburo, and SecretariatAll other ministries and agencies at every administrative level

Yen Bai, Vinh Phuc, Tuyen Quang, Nghe An, Bac Ninh, Binh Duong,and Da Nang Provinces

Center or Injury Policy and Prevention Research, Ha Noi School o PublicHealth*

Viet Nam Public Health Association*

Injury Prevention Network

Mass media (VTV, newspaper, radio)

Ho Nghia Dung, Minister o Transport

Pham Viet Cuong, Center or Injury Policy and Prevention Research, Ha NoiSchool o Public Health

Miss Viet Nam 2006 and other local celebrities

Motorcycle drivers and riders

INTERNATIONAL ACTORSWorld Bank

Global Road Saety Facility

Global Road Saety Initiative

Global Road Saety Partnership

Bloomberg Family Foundation

UN General Assembly

UN Development Programme

WHO Vietnam*

Child Injury Prevention Unit, UNICEF Vietnam*

Center or Accident and Road Saety, University o Queensland*French Red Cross

The Alliance or Sae Children*

Asia Injury Prevention Foundation*

Vietnam Saety Products and Equipment Co. (AIPF Protechelmet actory)*

The Government o the Netherlands

Asian Development Bank and ASEAN Regional Road Saety Program

APEC Transportation Committee

Japan Automobile Manuacturers Association and Japan Auto PartsIndustries Association

Ogilvy & Mather (Vietnam)

National Helmet Wearing Coalition

The Royal Danish Embassy

Danish International Development Agency

Counterpart International*

Toyota Vietnam Foundation

Klaus Rohland, World Bank

Ian Scott, The Alliance or Sae Children

Jon Passmore, WHO Vietnam

Isabelle Bardem, UNICEF-Vietnam

Jackie Chan

Michelle Yeoh

*The Atlantic Philanthropies grantee


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The Social Science Research CouncilOne Pierrepont Plaza

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